Iphs For Chc

Indian Public Health Standards (IPHS) for Community Health Centres (February 2007) (Revised)

Directorate General of Health Services Ministry of Health & Family Welfare Government of India

1

CONTENTS: Executive Summary

1

Introduction

4

Objectives of Indian Public Health Standards

5

Service Delivery in CHC

5

Minimum Requirements in CHC

8

Equipment

9

Drugs

9

Manpower

10

Physical Infrastructure

12

Capacity Building

21

Quality Assurance in Service Delivery

22

Record Maintenance

24

Checklists

25

List of Annexures: 1.

Revised National Tuberculosis Control programme

27

2.

National AIDS Control programme

32

3.

National Vector-borne Disease Control programme

34

4.

National Leprosy Eradication Programme

38

5.

National Blindness Control programme

47

6.

Integrated Disease Surveillance Project

49

7.

Referral Transport Model

52

8.

List of Equipment in CHC

53

9.

List of Drugs in CHC

64

10. GOI Guidelines for Blood Storage

89

11. List of Laboratory Services

95

12. Charter of Patients’ Rights.

97

13. Constitution of Task Group III and Consultation Process

List of Abbreviations:

100

103 Executive Summary

2

The Community Health Centres (CHCs) which constitute the secondary level of health care were designed to provide referral as well as specialist health care to the rural population. These centres are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the National Rural Health Mission (NRHM) gives us the opportunity to have a fresh look at their functioning.

In order to provide Quality Care in these CHCs Indian Public Health Standards (IPHS) are being prescribed to provide optimal expert care to the community and achieve and maintain an acceptable standard of quality of care. These standards would help monitor and improve the functioning of the CHCs.

Service Delivery: • All “Assured Services” as envisaged in the CHC should be available, which includes routine and emergency care in Surgery, Medicine, Obstetrics and Gynaecology and Paediatrics in addition to all the National Health programmes. • Appropriate Guidelines for each National Programme for management of routine and emergency cases are being provided to the CHC. • All the support services to fulfil the above objectives will be strengthened at the CHC level.

Minimum requirement for delivery of the above-mentioned services:

The following requirements are being projected based on the assumption that there will be average bed occupancy of 60%. The strength may be further increased if the occupancy increases with subsequent upgradation. As regards manpower, 2 specialists namely Anaesthetist and Public Health programme Manager will be provided on contractual basis in addition to the available specialists namely Surgery, Medicine, Obstetrics and Gynaecology and Paediatrics.

The support manpower will include a Public health Nurse and ANM in addition to the existing staff. An Ophthalmic Assistant will also need to be provided in centres where currently there is none. One Ophthalmologist (MS-Ophthal) for every 5 CHCs is recommended in addition to existing provisions. One Dental Surgeon, 6 GDMOs, One AYUSH specialist and One AYUSH general doctor are also recommended in this IPHS.

Facilities:

The equipment provided under the CSSM is deemed adequate. Physical Infrastructure will be remodelled or rearranged to make best possible use for optimal utilisation. New constructions will follow the

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specifications provided in this document. Space requirements for different functional areas has been listed out. Drugs will be as per the list provided with the document. AYUSH drugs are also being included. All the support services like laboratory, blood storage etc. will be strengthened.

Human Resource Management:

Capacity Building will be ensured at all levels by periodic training of all cadres.

Accountability:

It is mandatory for every CHC to have “Rogi Kalyan Samiti” to ensure accountability.

Every CHC shall have the Charter of Patients’ Rights displayed prominently at the entrance. A grievance redressal mechanism under the overall supervision of Rogi Kalyan Samitis would also be set up.

Quality of services:

Every CHC shall also have the Standard Operating Procedures and Standard Treatment Protocols for common ailments and the National Health Programmes.

Social audit by involvement of the community through Rogi Kalyan Samitis (RKSs) is being recommended. To maintain quality of services, external monitoring through Panchayati Raj Institutions and internal monitoring at appropriate intervals will be advocated. Guidelines are being provided for management of routine and emergency cases under the National Health Programmes so as to maintain uniformity in management in tune with the National Policy.

4

Introduction: Health care delivery in India has been envisaged at three levels namely primary, secondary and tertiary. The secondary level of health care essentially includes Community Health Centres (CHCs), constituting the First Referral Units (FRUs) and the District Hospitals. The CHCs were designed to provide referral health care for cases from the Primary level and for cases in need of specialist care approaching the centre directly. 4 PHCs are included under each CHC thus catering to approximately 80,000 populations in tribal / hilly areas and 1,20,000 population for plain areas. CHC is a 30-bedded hospital providing specialist care in medicine, Obstetrics and Gynaecology, Surgery and Paediatrics. These centres are however fulfilling the tasks entrusted to them only to a limited extent. The launch of the National Rural Health Mission (NRHM) gives us the opportunity to have a fresh look at their functioning.

NRHM envisages bringing up the CHC services to the level of Indian Public Health Standards. Although there are already existing standards as prescribed by the Bureau of Indian Standards for 30-bedded hospital, these are at present not achievable as they are very resource-intensive. Under the NRHM, the Accredited Social Health Activist (ASHA) is being envisaged in each village to promote the health activities. With ASHA in place, there is bound to be a groundswell of demands for health services and the system needs to be geared to face the challenge. Not only does the system require up-gradation to handle higher patient load, but emphasis also needs to be given to quality aspects to increase the level of patient satisfaction. In order to ensure quality of services, the Indian Public Health Standards are being set up for CHCs so as to provide a yardstick to measure the services being provided there. This document provides the requirements for a Minimum Functional Grade of a Community Health Centre.

The IPHS for CHC has been worked out by constituting a Task Group III under NRHM comprising of various stakeholders under the chairmanship of Director General of Health Services, Ministry of Health & Family Welfare, Government of India (Annexure 13).

Objectives of Indian Public Health Standards (IPHS) for CHCs: •

To provide optimal expert care to the community

•

To achieve and maintain an acceptable standard of quality of care

•

To make the services more responsive and sensitive to the needs of the community.

Service delivery in CHCs:

Every CHC has to provide the following services which can be known as the Assured Services:

5

♦

Care of routine and emergency cases in surgery:

•

This includes incision and drainage, and surgery for Hernia, Hydrocele, Appendicitis, Haemorrhoids, Fistula, etc.

•

♦

Handling of emergencies like Intestinal Obstruction, Haemorrhage, etc.

Care of routine and emergency cases in medicine:

•

Specific mention is being made of handling of all emergencies in relation to the National Health Programmes as per guidelines like Dengue Haemorrhagic Fever, Cerebral Malaria, etc. Appropriate guidelines are already available under each programme, which should be compiled in a single manual.

♦

24-hour delivery services including normal and assisted deliveries

♦

Essential and Emergency Obstetric Care including surgical interventions like Caesarean Sections and other medical interventions

♦

Full range of family planning services including Laparoscopic Services

♦

Safe Abortion Services

♦

New-born Care

♦

Routine and emergency care of sick children

♦

Other management including nasal packing, tracheostomy, foreign body removal etc.

♦

All the National Health Programmes (NHP) should be delivered through the CHCs. Integration with the existing programmes like blindness control, Integrated Disease Surveillance Project, is vital to provide comprehensive services. The requirements for the important NHPs are being annexed as separate guidelines with the document.

•

RNTCP: CHCs are expected to provide diagnostic services through the microscopy centres which are already established in the CHCs and treatment services as per the Technical Guidelines and Operational guidelines for Tuberculosis Control (Annexure 1).

•

HIV/AIDS Control Programme: The expected services at the CHC level are being provided with this document which may be suitably implemented (Annexure 2).

•

National Vector Borne Disease Control Programme: The CHCs are to provide diagnostic and treatment facilities for routine and complicated cases of Malaria, Filaria, Dengue, Japanese Encephalitis and Kala-azar in the respective endemic zones (Annexure 3).

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•

National Leprosy Eradication Programme (NLEP): The minimum services that are to be available at the CHCs are for diagnosis and treatment of cases and reactions of leprosy along with advice to patient on Prevention of Deformity (Annexure 4).

•

National Programme for Control of Blindness: The eye care services that should be available at the CHC are diagnosis and treatment of common eye diseases, refraction services and surgical services including cataract by IOL implantation at selected CHCs optionally. 1 eye surgeon is being envisaged for every 5 lakh population (Annexure 5).

•

Under Integrated Disease Surveillance Project, the related services include services for diagnosis for Malaria, Tuberculosis, Typhoid and tests for detection of faecal contamination of water and chlorination level. CHC will function as peripheral surveillance unit and collate, analyse and report information to District Surveillance Unit. In outbreak situations, appropriate action will be initiated (Annexure 6).

♦

Others:

•Blood Storage Facility •Essential Laboratory Services (Annexure 11) •Referral (transport) Services (Annexure 7)

7

Minimum requirement for delivery of the above-mentioned services:

The following requirements are being projected based on the assumption that there will be average bed occupancy of 60%. The strength may be further increased if the occupancy increases with subsequent upgradation.

Certain suggestions for offsetting the deficiencies in the availability of required manpower: • Anaesthetists: o

Diploma and MD seats for post-graduation in Anaesthesia to be increased across the country. However care should be taken to only include institutions with assured quality and able to provide adequate clinical training.

o

Certificate course for one year in Anaesthesia by the National Board of Examinations

• Public Health Programme Manager: o

Diploma and MD seats for post-graduation in Public Health to be increased across the country. However care should be taken to only include institutions with assured quality and able to provide adequate field and community-based training.

o

Persons with MD / DNB degrees in Family Medicine, Hospital Administration, Public Health, Community Health Administration ,Maternal and Child health are to be recognized for the post and made at par with MD(PSM).

o

Persons who have completed the Professional Development Course of 3 months with a 9-month field training in recognized training institute may also be eligible for the same. This may also be seen as a career advancement avenue for Medical Officers serving in PHCs who may be eligible for the post after a stint of 3-4 years in PHC and completion of this course.

Equipment: •

The list of equipment provided under the CSSM may be referred to as they are deemed to be adequate for providing all services in the CHC (Annexure 8). Before ordering new sets, the existing equipment should be properly assessed.

•

For ophthalmic equipment wherever the services are available, Annexure no.5 may be referred to.

•

Maintenance of equipment. It is estimated that 10-15% of the annual budget is necessary for maintenance.

•

2 Refrigerators, one for the ward and one for OT should be available in the CHC. Sharing of Refrigerator with the lab should be possible.

8

•

Appropriate standards for equipments are already available in the Bureau of Indian Standards. If standards for any equipment are not available, technical specifications for the equipment may be prepared by the technical committee for the process of tendering and procurement.

Drugs:

The list of essential drugs and emergency drugs are provided as Annexure 9. Programme specific drugs are detailed in the Guidelines under each programme. AYUSH drugs are being included.

Manpower:

In order to provide round the clock clinical services, there is likelihood of shortage of doctors in 8-hourly shift duties. This shortage can be compensated by resource pooling (Block Pooling Concept) of available doctors posted at Primary Health Centres covered under the CHC.

Under the present scenario of shortage of clinical manpower, it is suggested that doctors of PHCs may be located at CHCs while attending to routine OPD duties at PHCs of the catchment area and are required to do shift duties to provide emergency services at CHC. For enabling these doctors to perform duties in wider geographic area, they should be provided with mobile phones and transport facilities to commute beween block headquarter to PHC.

Personnel Block Health Officer

Strength -

Desirable qualifications Senior most specialists among the below mentioned specialists (Physician / General surgeon / Paed. / Obs & Gyne/ Anaesthesia / Public Health / Ophthalmology)

General Surgeon Physician

1

MS/DNB, (General Surgery)

1

MD/DNB, (General Medicine)

Justification Will be responsible for coordination of NHPs, management of ASHAs, Training and other responsibilities under NRHM apart from overall administration / Management of CHC etc.

9

Personnel Obstetrician & Gynaecologist Paediatrics Anaesthetist

Strength 1

Desirable qualifications MD/DNB/DGO (OBG)

1 1

MD(Paediatrics)/DNB/DCH MD(Anesthesia)/DNB/DA/ Certificate course in Anaesthesia for one year

Public Health Manager

1

Eye surgeon

1 (1 every CHCs)

MD (PSM)/MD (CHA)/MD Community Medicine or Post Graduation Degree with MBA MD/MS/DOMS/DNB/(Ophthal)

Dental Surgeon General Duty Medical Officer

1 6 (at least 2 female doctors) 1

BDS MBBS

1

Graduate in AYUSH

Specialist of AYUSH General Duty Medical Officer of AYUSH Total

for five

Justification

Essential for utilization of the surgical specialities. They may be on contractual appointment or hiring of services from private sectors on per case basis.

1 for every 5 CHCs as per Vision 2020 approved Plan of Action.

Post Graduate in AYUSH

15/16

Support manpower:

Personnel Staff Nurse Public Health Nurse (PHN) ANM Pharmacist/compounder Pharmacist – AYUSH Lab. Technician Radiographer Ophthalmic Assistant Dresser (certified by Red Cross/ St. Johns Ambulance) Ward Boys / Nursing Orderly Sweepers Chowkidar Dhobi Mali Aya Peon OPD Attendant Registration Clerk

Strength 19** 1* 1* 3 1 3 2 1 2 5 5 5 1 1 5 2 1 2

10

Personnel Statistical Assistant / Data Entry Operator Accountant / Admin. Assistant OT Technician Total

Strength 2 1 1 64

*

Will be appointed under the ASHA scheme.

**

for providing round the clock service at OT, Labour Room, casualty, male ward and female ward along with provision of leave reserve.

Central government shall periodically review the staffing norms and modify it somewhat if required. States shall as per provision under NRHM explore keeping part time / contractual staff wherever deficient.

Investigative facilities at the CHC: • In addition to the lab facilities in the CHC, ECG should be made available in the CHC with appropriate training to a nursing staff. • All necessary reagents, glass ware and facilities for collecting and transport of samples should be made available.

Physical Infrastructure:

The CHC should have 30 indoor beds with one Operation theatre, labour room, X-ray facility and laboratory facility. In order to provide these facilities, following are the guidelines:

o

Location of the centre: To the extent possible, the centre should be located at the centre of the block headquarter in order to improve access to the patients. This may be applicable only to centres that are to be newly established.

However, priority is to be given to operationalise the existing CHCs. Building should be quake proof, fire proof and flood proof. Infrastructure should be eco-friendly and disabled (physically and visually handicapped) friendly. Provision should be made for water harvesting, generating back-up, solar energy / power back-up, and horticulture services including herbal garden.

The building should have areas/ space marked for the following:

o

Entrance zone:

11

o

Prominent display boards in local language providing information regarding the services available and the timings of the institute

o

Registration counters

o

Pharmacy for drug dispensing and storage

o

Clean Public utilities separate for males and females

o

Suggestion / complaint boxes for the patients/ visitors and also information regarding the person responsible for redressal of complaints.

o

Outpatient department: o

Clinics for Various Medical Disciplines – These clinics include general medicine, general surgery, dental (optional), obstetric and gynaecology, paediatrics and family welfare. Separate cubicles for general medicine and surgery with separate area for internal examination (privacy) can be provided if there are no separate rooms for each. The cubicles for consultation and examination in all clinics should provide for doctor’s table, chair, patient’s stool, follower’s seat, wash basin, examination couch and equipment for examination.

o

Room shall have, for the admission of light and air, one or more apertures, such as windows and fan lights, opening directly to the external air or into an open verandah. The windows should be in two opposite walls.

o

Family Welfare Clinic – The clinic should provide educative, preventive, diagnostic and curative facilities for maternal, child health, school health and health education. Importance of health education is being increasingly recognized as an effective tool of preventive treatment. People visiting hospital should be informed of environmental hygiene, clean habits, need for taking preventive measures against epidemics, family planning, etc.

Treatment room in this clinic should act as operating room for IUCD

insertion and investigation, etc. It should be in close proximity to Obstetric & Gynaecology OPD. o

Waiting room for patients

o

The Pharmacy should be located in an area conveniently accessible from all clinics. The dispensary and compounding room should have two dispensing windows, compounding counters and shelves. The pattern of arranging the counters and shelves shall depend on the size of the room. The medicines which require cold storage and blood required for operations and emergencies may be kept in refrigerators.

o

Emergency Room/ Casualty: The emergency cases may be attended by OPD during OPD hours and in inpatient units afterwards.

o

Treatment Room:

12

o

o

Minor OT

o

Injection Room and Dressing Room

Wards: Separate for males and females o

Nursing Station– The nursing station shall be centered such that it serves all the clinics from that place. The nursing station should be spacious enough to accommodate a medicine chest / a work counter for preparing dressings, medicines, sinks, dressing tables with screen in between and pedal operated bins to hold soiled material. It should have provision for:

•

•

o

Injections,

o

Dressings,

o

Examination and dressing table,

o

Bins for waste material,

o

Wash basins,

o

Syringe destroyer

o

Needle cutter

Patient Area: o

Enough space between beds.

o

Toilets; separate for males and females.

o

Separate space/ room for patients needing isolation

Ancillary rooms: o

Nurses rest room

•

There should be an area separating OPD and Indoor facility.

•

Operation theatre/ Labour room: o

Patient area: o

o

Pre-operative and Post-operative (recovery) room

Staff area: o

Changing room separate for males and females

o

Storage area for sterile supplies

o

OT/ Labour room area: o

Operating room/ labour room

o

Scrub area

13

o

Instrument sterilization area

o

Disposal area

•

Public utilities: Separate for males and females

•

Physical infrastructure for Support services: o

CSSD: o

o

Sterilization and Sterile storage

Laundry: o

Storage: separate for dirty linen and clean linen Outsourcing is recommended after appropriate training of washer man regarding separate treatment for infected and non-infected linen.

o

Services: Electricity / telephones / water / civil Engineering may be outsourced. Maintenance of proper sanitation in toilets and other public utilities should be given utmost attention. Sufficient funding for this purpose must be kept and the services may be outsourced. •

Water Supply – Arrangements shall be made to supply 10,000 litres of potable water per day to meet all the requirements (including laundry) except fire fighting. Storage capacity for 2 days requirements should be on the basis of the above consumption. Round the clock water supply shall be made available to all wards and departments of the hospital. Separate reserve emergency overhead tank shall be provided for operation theatre.

Necessary water storage overhead tanks with

pumping/boosting arrangement shall be made.

The laying and

distribution of the water supply system shall be according to the provisions of IS: 2065-1983*. Cold and hot water supply piping should be run in concealed form embedded into wall with full precautions to avoid any seepage. Geyser in O.T. / L.R. and one in ward also should be provided. Wherever feasible solar installations should be promoted. •

Emergency lighting – Emergency portable / fixed light units should also be provided in the wards and departments to serve as alternative source of light in case of power failure. Generator back-up should be available in all facilities. Generator should be of good capacity. Use of solar energy wherever feasible may be used.

•

Telephone: minimum two direct lines with intercom facility should be available.

•

Administrative zone: Separate rooms should be available for

14

o

Office

o

Stores

15

Function & Space Requirement for 30 beds Hospital (Community Health Centre)

It is Suggested considering the land cost & availability of land, CHC building may be constructed in two floors Function & Space Requirement for different zones Zone Functions Entrance Zone

Ambulatory Zone (OPD )

Registration & Record storage, Pharmacy (Issue counter/Formulation/Drug storage) Public utilities & circulation space

Examination & Workup (Examination Room, sub waiting), Consultation (consultation room Toilets, sub waiting) Nursing station (Nurses desk, clean utility, dirty utility, treatment rooms, injection & dressing),ECG (sub waiting, Casualty/Emergency, public utilities, circulation space

Area requirement for each sub-function Registration /Record Room 3.2X 3.2 X 2

Total Areas in Sq Mtrs

Que area outside registration room 3.5X3

10.5 Sq. Mtrs

20.48 Sq Mtrs

Pharmacy cum store 6.4X3.2Mtrs

20.48 Sq Mtrs

Pharmacy cum store for AYUSH 6.4X3.2Mtrs

20.48 Sq Mtrs

Space for 4 general Doctor Room 3.2 X 3.2 X4 Space for 2 AYUSH doctors Room 3.2 X 3.2 X2

40.96 Sq Mtrs

20.48 Sq Mtrs 8 specialist room with attach toilets = 3.7X 3.2 X8 Treatment room 3.7 X 3.2 Refraction room 3.2X3.2 Nursing Station 6.4 X 3.2 Casualty 6.4 X 6.4 Dress Room 3.2 X 3.2 Injection Room 3.2 X 3.2 Female injection room 3.2X3.2 Public Utility / Common Toilets Waiting Area

94.72 Sq Mtrs

11.84 Sq Mtrs 10.24 Sq Mtrs 20.48 Sq Mtrs 40.96 Sq Mtrs 10.24 Sq Mtrs 10.24 Sq Mtrs 10.24 Sq. Mtrs 9.5 Sq Mtrs

Diagnostic Zone

Pathology (Optional) Laboratory, sample collection, bleeding room, washing disinfections storage, sub waiting. Imaging (radiology, radiography, ultra-sound) Preparation, change, toilet, control, Dark room, treatment room sub waiting public utilities

31.5 Sq Mtrs 180 Sq Mtrs

16

Zone Intermediate Zone (inpatient Nursing units)

Critical Zone (Operational Theater/Labo ur room

Service Zone

Functions Nursing station(Nurse desk,clean utility , treatment room , pantry ,store, sluice room ,trolly bay) patient area(bed space, toilets, Day space, Isolation Space) Ancillary rooms (Doctor’s rest room, Nurses duty room, Public utilities ,circulation space.

Patient area (Preparation, Preanaesthesia, post operative resting ) Staff area (Changing Resting ) Supplies area (trolley bar, equipment storage ,sterile storage) OT/LR area (Operating /Labour room, scrub, instrument sterilization, Disposal) public utilities, circulation space Dietary (Dry Store, Day Store, Preparation, Cooking, Delivery, pot wash, Utensil wash, Utensil store, trolley park) C.S.S.D. (Receipt, wash, assembly, sterilization, sterile storage, Issue) Laundry (Receipt, weigh, sluice/wash, Hydro extraction, tumble, calender, press) Laundry (clean storage, Issue), Civil engineering (Building maintenance, Horticulture, water supply, drainage and sanitation) Electrical engineering (sub station & generation, Illumination, ventilation) Mechanical engineering, Space for other service like ,gas store, Telephone intercom fire protection , waste disposal, Mortuary. General Administration, general store, public utilities circulation space

Administrativ e zone Total Circulation Area / Corridors Total Area

Area requirement for each sub-function Nursing station 6.4 X 6.4 4 wards each with 6 beds ( 2 male wards & 2 female wards) size (6.2 X 6.2 ) X 4 4 private room (2 each for for male & females) with toilets 6.2 X 3.2 X 4 2 isolation rooms with toilet (one each for male & female) 6.2 X 3.2 X 2

Total Areas in Sq Mtrs 40.96 Sq Mtrs

153.76 Sq Mtrs

79.36 Sq Mtrs

39.68 Sq Mts 240 Sq Mtrs

Services like Electrical engineering /Mechanical engineering & civil engineering can be privately hired to avoid permanent space in the CHC building

60 Sq Mtrs

191.15 Sq Mtrs 1503.32 Sq Mtrs

17

Capacity building: • Training of all cadres of worker at periodic intervals is an essential component. • Multi skill training for paramedical workers

18

Quality Assurance in Service Delivery

•

Quality of service should be maintained at all levels. Standard treatment protocol for all national programmes and locally common diseases should be made available at all CHCs. Standard Treatment protocol: is the “Heart” of quality and cost of care. All the efforts that are being made to improved “hardware i.e. infrastructure” and “software i.e. human resources” are necessary but NOT sufficient. These need to be guided by Standard Tr eatment Protocols. Some of the states have already prepared these guidelines.

•

Diet: Diet may either be outsourced or adequate space for cooking should be provided in a separate space.

•

CSSD: Adequate space and standard procedures for sterilization and Sterile storage should be available.

•

Laundry: o

Storage: Separate for dirty linen and clean linen

o

Outsourcing is recommended after appropriate training of washer man regarding separate treatment for infected and non-infected linen.

•

Services: Electricity / telephones / water / civil engineering may be outsourced.

•

Blood Storage Units: The GOI guidelines as given in Annexure may be referred to. (Annexure 10)

•

Waste Disposal: “Guidelines for Health Care Workers for Waste Management and Infection Control in Community Health Centres” to be followed are being formulated.

•

Charter of Patient Rights: It is mandatory for every CHC to have the Charter of Patient Rights prominently displayed at the entrance. Details are provided in the Annexure 12.

•

Quality Control: o

Internal monitoring: §

Routine Monitoring by District Health Authority.

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§

Social

Audit:

Through

Rogi

Kalyan

Samitis/

Panchayati

Raj

Institution, etc. §

Medical audit

§

Others like technical audit, economic audit, disaster preparedness audit, etc.

§

o

•

Access to patients

•

Registration and admission procedures

•

Examination

•

Information exchange

•

Treatment

•

Other facilities: waiting, toilets, drinking water

•

Indoor patients: o

Linen/ beds

o

Staying facilities for relatives

o

Diet and drinking water

o

Toilets

External Monitoring: §

o

Patient care: This shall include:

Gradation of the centre by PRI (Zilla Parishad) / Rogi Kalyan Samitis

Monitoring of laboratory: •

Internal Quality Assessment scheme

•

External Quality Assessment scheme

Record maintenance: Computers are to be used for accurate record maintenance.

o

Suggested innovations: o

Water harvesting should be introduced in all new buildings

o

Computerisation is a must and would be essential for record maintenance and surveillance.

o

To maintain the hospital landscaping, a room to store garden implements; seeds, etc, should be provided.

20

Checklist for minimum requirement of CHCs Services

Existing

Remarks

Population covered Specialist available Medicine

services

Surgery OBG Paediatrics NHPs Emergency services Laboratory Blood Storage Infrastructure (As per specifications) Area of the Building

Existing

Remarks

OPD rooms/cubicles Waiting room for patients No. of beds: Male No. of beds: Female Operation theatre Labour room Laboratory X-ray Room Blood Storage Pharmacy Water supply Electricity Garden Transport facilities Checklist for Equipment Equipment

available

Functional

Remarks

(As per list)

21

Checklist for Drugs: Drugs

Existing

Remarks

Available

Whether functional as per norms

(As per Essential Drug list)

Checklist for Audit: Particulars Patient’s charter Rogi Kalyan Samiti Internal monitoring External Monitoring Availability of SOPs/STPs* *Standard Operating Procedures/ Standard Treatment Protocols

Annexure 1

Requirements with regard to Revised National TB Control Programme for Indian Public Health Standards at CHC Level.

Diagnostic services

-

A Microscopy Centre (MC) is established for 1,00,000 population. For hilly, tribal and difficult areas MC is established for 50,000 populations. The Microscopy Centres are established at PHC, CHC or District Hospital.

-

Inputs

22

i.

RNTCP has provided inputs to upgrade the infrastructure through minor civil works of the existing laboratories to be able to come up to the minimum standard required to carry out sputum microscopy. At present, about 87% of the country is covered under RNTCP and it is envisaged to cover the entire country by June 2005.

ii.

Manpower: Existing Laboratory Technicians (LTs) are provided training and they function as LTs to carry out sputum microscopy. For up to 20% of the requirements of the LTs at designated Microscopy Centres at the District level, LTs are provided by RNTCP on contractual basis.

iii.

Equipment: Binocular Microscopes are provided to the Microscopy Centres for sputum microscopy.

iv.

Laboratory Consumables: Funds are provided to the District TB Control Societies for procurement and supply of all the consumables required to carry out sputum microscopy.

The list of laboratory consumables

required at MC is enclosed at Annexure-I

Treatment Services

1.

Medical Officers: All Medical Officers are trained in RNTCP to suspect chest symptomatics, refer them for sputum microscopy and be able to categories the patients and handle side effects of anti TB drugs.

2.

DOTS Centres: All sub-centres, PHCs, CHCs and District Hospitals work as DOTS Centres. In addition, the community DOTS providers are also trained to deliver DOT.

A room of the CHC is used to function as DOTS centre.

Facilities for seating and making available drinking water to the patients for consumption of drugs are provided under the Programme. 3.

DOTS Providers: The Multi Purpose Workers (MPWs), Pharmacists and Staff Nurses are trained in to monitor consumption of anti TB drugs by the patients.

4.

All the DOTS providers to deliver treatment as per treatment guidelines. All the doctors to categories patients as per treatment guidelines (refer Technical Guidelines).

5.

Drugs in patient wise boxes and loose drugs are provided at DOT Centres through District TB Centre (DTC). Details of the drugs given at Annexure-2.

6.

Recording and reporting to be done as per Operational Guidelines (refer Operational Guidelines).

23

Treatment of complicated cases

1.

For patients who require admission (Pleural Effusion, Emphysema etc.) drugs are provided in the form of prolongation pouches through District TB Centre for indoor treatment.

2.

The common complications of TB can be treated by the Medical Officers/ Specialists at CHC and side effects of drugs can also be handled by the doctors at CHC.

Quality Assurance

1.

Diagnosis: The diagnostic services are supervised by Senior TB Laboratory Supervisor (STLS) for all the Microscopy Centres at the sub-district level (5,00,000 population or 2,50,000 population in the hilly, difficult and tribal areas).

2.

Treatment: All major drugs procured at the Centre through World Bank recommended procedures and provided to the States, thereby assuring quality of the drugs.

24

LIST OF ANTI-TB DRUGS PROCURED UNDER NATIONAL TB CONTROL PROGRAMME

Sl.No

1.

Product Code Number Product Code-I Treatment box for Cat-I patient

2.

Product Code-2 Treatment box for Cat-II patient

3.

Product Code-3 Treatment box for Cat-III patient

4.

Product Code-4 Treatment box for prolongation of Intensive Phase of Cat-I &Cat. II

Product Description

Strength

Treatment box for Cat.I patient. Each treatment box containing 24 combipacks of Schedule-I in one pouch and 18 multi-blister calendar combi-pack of Schedule-2 in another pouch

Each combi-pack of

Treatment box for Cat.II patient. Each treatment box containing 36 combipacks of Schedule-I in one pouch and 22 multi-blister calendar combi-pack of Schedule-3 in another pouch

Each combi-pack of

Treatment box for Cat.III patient. Each treatment box containing 24 combipacks of Schedule-4 in one pouch and 18 multi-blister calendar combi-pack of Schedule-2 in another pouch Treatment box for Prolongation of Intensive Phase of Cat.I & Cat.II patient. Each box containing 5 pouches and each pouch containing 12 blister combi-pack of Schedule-1

Each combi-pack of

Schedule-I containing 1 R Cap.of 450mg 2 II Tabs. of 300mg each 2 E Tabs of 600mg each 2 Z Tabs. of 750mg each

Schedule-I containing 1 R Cap. of 450mg 2 II Tabs. of 300mg each 2 E Tabs of 600mg each 2 Z Tabs. of 750mg each

Schedule-4 containing 1 R Cap.of 450mg 2 H Tabs. of 300mg each 2 Z Tabs. of 750mg each

Each multi-blister calender combi-pack of Schedule-2 containing 3 R Caps.of 450 mg each 6 H Tabs. of 300mg each 4 Pyrioxine Tabs of 5mg each

Each multi-blister calender combi-pack of Schedule-3 containing 3 R Caps. of 450 mg each 6 H Tabs. of 300mg each 6 E Tabs of 600mg each 4 Pyrioxine Tabs of 5mg each

Each multi-blister calender combi-pack of Schedule-2 containing 3 R Caps.of 450 mg each 6 H Tabs. of 300mg each 4 Pyrioxine Tabs of 5mg each

Each combi-pack of Schedule-I containing 1 2 2 2

R Cap.of 450mg H Tabs. of 300mg each E Tabs of 600mg each Z Tabs. of 750mg each

25

5.

Product Code-5

Loose Packs Streptomycin Vials

of

Each vial of 750mg

6.

Product Code-6

Blister strips containing

pack

10 Rifampicin Capsule of 150mg each

7.

Product Code-7

Blister strips containing

pack

10 INH Tablet of 100mg

8.

Product Code-8

Blister strips containing

pack

10 Pyrazinamide Tablets of 500mg

9.

Product Code-10

Blister strips pack or Foil Packs containing

10 E Tabs of 800mg each

10.

Product Code-11

Blister strips containing

pack

10 H Tabs of 300mg each

11.

Product Code-12

Blister strips containing

pack

10 Rifampicin Capsules of 450 mg each

R= Rifampicin; H= Isoniazid; E= Ethambutol; Z= Pyrazianamide; S.M= Inj. Streptomycin.

Annexure 2 NATIONAL AIDS CONTROL PROGRAMME: HIV GUIDELINES

At present the preventive and care interventions for the control of HIV/AIDS are being provided below district level through integrated Health Care System using the available staff. There is also a provision of training of health care providers and generating awareness through intensive IEC campaign. The programme is being further strengthened by converging the activities under NACP with RCH programme, which is underway. The following activities are being proposed to be integrated at CHC level.

S.No 1.

Activities RTI / STD management services

Proposed Expansion of services up to CHC & 24 hours PHC. Basic screening test for RTI/STD to be made available at the CHCs.

2.

VCTC & youth information centres

Expansion of services up to CHCs in all States

26

3.

Prevention

of

parent -to-Child

Services to be provided at all CHCs

Communication

Joint communication strategy messages &

Transmission (PPTCT) 4.

5.

Behaviour

Change

(BCC)

medium development to be done

Condom promotion

Joint condom procurement & distribution of condoms to meet the needs of sexually active women and men as a method of dual protection

6.

Blood safety

Blood storage centres planed at FRUs will procure blood from licensed blood banks but will be supported by RCH

7.

Trainings

A specific plan will be developed jointly by both the departments to train the peripheral staff at CHC

8.

Management Information System

Al facilities to report service performance on RTI/STI, VCTC, PPTCT as a part of routine reporting

9.

Operationalisation

A convergence facilitator to be appointed to ensure

coordinated

inputs

between

the

activities implemented by NACP and RCH

27

Annexure 3 NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME The National Vector Borne Disease Control Programme (NVBDCP), erstwhile National Anti Malaria Programme (NAMP) is the country’s most comprehensive and multi-faceted public health activity. Directorate of NVBDCP is the nodal agency for prevention and control of major vector borne diseases of public health importance namely Malaria, Filariasis, Japanese Encephalitis (JE), Kala-azar and Dengue.

Following are the strategy for control of these diseases:-

a)

Malaria: •

Early Diagnosis and prompt treatment of malaria cases

•

Integrated vector control

•

Early Detection and Containment of malaria outbreak

•

Information, Education and Communication (IEC) for personal protection and community involvement for malaria control

b)

•

Training and Capacity Building of Medical and Para-medical workers

•

Monitoring and evaluation of Efficient Management Information System (MIS)

Dengue: •

Epidemiological Surveillance of Dengue cases

•

Entomological surveillance of Aedes aegypti mosquitoes

•

Clinical management of reported cases

•

Control of mosquitoes through Integrated Vector Management including source reduction, use of larvivorous fishes, impregnated bednets and selective fogging with Pyrethrum

•

Behaviour change communication to change behavior of the community about prevention of breeding of mosquitoes

c)

Kala-azar: •

Early diagnosis & complete treatment through Primary Health Care System

28

•

Interruption of transmission through vector control by undertaking residual insecticidal spraying in affected areas

•

d)

Health Education and community participation

Japanese Encephalitis: •

Vector control by insecticidal spraying with appropriate insecticide for outbreak containment

e)

•

Early diagnosis and prompt clinical management to reduce fatality

•

Health Education

•

Training of Medical Personnel and Professionals

Filariasis:

For elimination of Lymphatic Filariasis following are the strategies:•

Annual Mass Drug Administration (MDA) with single dose of DEC to all eligible population at risk of Lymphatic Filariasis

•

Home based management of Lymphodema cases and

•

Hydroceloctomy

To provide the above services under NVBDCP the PHC Medical Officers are the In-charge of PHC. The diagnosis, treatment and examination are performed at CHCs as per the pattern of PHC.

In addition, CHCs are the first referral units for treatment of severe and complicated

malaria cases. To provide following services, the CHCs should be equipped with the items as mentioned at Annexure:

Diagnosis of malaria cases, microscopic confirmation and treatment Cases of suspected JE and Dengue to be provided symptomatic treatment, hospitalization and case managements. Complete treatment to Kala-azar cases in Kala-azar endemic areas Complete treatment of micro-filaria positive cases with DEC and participation & arrangement of MDA along with preparedness of management of side reactions.

Standards:

29

The CHC Medical Officer should be well-trained in the control programme of the Vector Borne Diseases and should carry out the following activities:-

a)

He will, in consultation with District Malaria Officer and the community, select FTD/DDC holders and Voluntary Link Workers for his PRIMARY HEALTH CARE

b)

He will refer all fever cases to malaria laboratory for blood smear collection

and

examination

before

giving

final

prescription/medicines. c)

He will supervise all Malaria Cinics and PHC laboratory in his area, see the quality of blood smear collection, staining, efficiency microscopic examination and check whether the stain is filtered daily.

d)

He will also ensure/supervise that all positive cases get radical; treatment within 48 hours of examination.

e)

He will also ensure that sufficient stocks of Anti-malarials including Quinine tablets and injectable Quinine and Artemisenine are available in CHC and also PHCs

f)

He will ensure that malaria laboratory is kept in proper condition along with microscope and other equipments.

g)

He will provide referral services to severe cases of malaria

h)

He will refer severe and complicated cases to District Hospital in case of emergency and drug failure.

i)

He will also ensure that Filaria cases are managed at CHC and the Hydrocele cases are operated.

1.

Drugs:

Chloroquine, Primaquine, Sulphadoxin Pyremethamine Combination,

Artemisinine

Derivatives, Quinine Injections, Quinine tablets and 5% Dextrose saline And DEC tablets

2.

Equipment :

30

Microscope, Slides, Pricking Needles, Cotton, Stains, Staining Jars, Filter paper, Glass marking pencil, Lint cloth and Glasswares for preparation of stains and storage.

3.

IEC Material:

•

Display material like posters, banners and permanent hoardings etc.

•

Distribution material like handbills, pamphlets, booklets display cards etc.

•

Training Materials like Guidelines on programme strategies, dose-schedule cards etc.

31

Annexure 4 NATIONAL LEPROSY ERADICATION PROGRAMME Minimum services to be available at Community Health Centres (CHC). •

Diagnosis of Leprosy

•

Treatment

•

Management of Reactions

•

Advise to Patient on POD Care

1. Leprosy Case Diagnosis Manpower required ♦

Medical Officer trained in leprosy diagnosis

♦

Pharmacist to issue medicine and manage MDT Stock

♦

Health Worker trained to maintain records/ reports

Methodology

•

By following Standard National Guidelines (Annexure-I).

2. Treatment of Cases

♦ CHC should have MDT Blister Packs {MB(A), MB(C), PB(A), PB(C)} at least 3 months stock against patients under treatment. ♦ The CHC will classify and treat leprosy which MDT as per National Guidelines

3. Management of Reaction Cases

♦ The CHC should have adequate stock of prednisolone tablets for management of reaction cases as per National Guidelines (Annexure-3).

32

4. Advise to patient for prevention of deformity and Ulcer Care. ♦

CHC should have a Medical Officer, Pharmacist, Health Worker properly trained for providing counselling to the patients. (Annexure-4)

Leprosy Case Diagnosis 1. How to Diagnose Leprosy?

Signs of Leprosy A leprosy patient is someone who has a skin patch or patches with a definite loss of sensation and has not completed a full course of treatment with multi-drug therapy.

Leprosy patches: Can be pale or reddish or copper-coloured, can be flat or raised, do not itch, usually do not hurt, lack sensation to heat, touch or pain, can appear anywhere.

Other signs of leprosy include: Reddish or skin-coloured nodules or smooth, shiny diffuse thickening of the skin without a loss of sensation.

2. Which Signs is Not Leprosy?

Skin patches …. Ø

Present from birth (i.e. birth marks)

Ø

Where there is normal feelings

Ø

That itch

Ø

That are white, black or dark red

Ø

With scaling or skin

Ø

That appear or disappear suddenly and spread fast

33

3. How to Examine a Patient for Leprosy? Ø

Examine the skin in daylight or in a well-lit room

Ø

Examine the whole body, taking care to respect the patient’s privacy

Ø

Ask the patient if the patch itches. If so, it cannot be leprosy

Ø

Test only one or two skin patches for sensory loss

Ø

If there is a definite loss of sensation, it is leprosy

Ø

Ask about treatment received in the past

Ø

A person who has completed a full coursed of MDT very rarely needs further treatment

Ø

Look for any visible disability of eyes, face, hands and feet

Ø

When in doubt about the diagnosis, always send the patient to the nearest referral centre.

4. How to Test for Sensory Loss? Ø

Take a pointed object such as a pen

Ø

Show the person what you are going to do.

Ø

Lightly touch the skin with the pen

Ø

Ask the person to point to where they felt the pen

Ø

Now ask them to close their eyes so that they cannot see what you are doing

Ø

Lightly touch the centre of the most prominent skin patch and ask them to point to where they felt the pen

Ø

Repeat the procedure on normal skin and on the same patch again.

Ø

If the person feels nothing on the skin patch, it is leprosy. Start treatment immediately.

5. How to Classify Leprosy?

Leprosy is classified into Paucibacillary or Multibacillary leprosy based on the number of patches.

> 1-5 patches? It is Paucibacillary (PB) leprosy. Treatment: 6 PB Blister Packs

> More than 5 patches ? It is Multibacillary (MB) leprosy. Treatment: 12 MB Blister Packs

Treatment of Leprosy Cases MDT Regimens

34

MDT supply in separate blister packs for MB (Adult), MB (Child), PB (Adult) & PB (Child). Each Blister Pack contains treatment for 4 weeks. 1. PB Adult Treatment:

Once a month : 1 Day - 2 Capsules of Rifampicin (300 mg X 2) - 1 Tablet of Dapsone (100 mg)

Once a day : Days 2-28 - 1 Tablet of Dapsone (100 mg)

2. MB Adult Treatment :

Once a month : 1 Day - 2 Capsules of Rifampicin (300 mg X 2) - 3 Capsules of Clofazimine (100 mg X 3) - 1 Tablet of Dapsone (100 mg)

Once a day : Days 2-28 - 1 Capsule of Clofazimine (50 mg) - 1 Tablet of Dapsone (100 mg)

FULL COURSE: 12 MONTHS It is crucial that patients understand which drugs they have to take once a month and which every day. 3. PB Child Treatment (10-14 years) :

Once a month : 1 Day - 2 Capsules of Rifampicin (300 mg + 150 mg) - 1 Tablet of Dapsone (50 mg)

Once a day : Days 2-28 - 1 Tablet of Dapsone (50 mg)

35

FULL COURSE: 6 Blister Packs For Children younger than 10, the dose must be adjusted according to body weight.

4. MB Child Treatment (10-14 years) :

Once a month : 1 Day - 2 Capsules of Rifampicin (300 mg + 150 mg) - 3 Capsules of Clofazimine (50 mg X 3) - 1 Tablet of Dapsone (50 mg)

Once a day : Days 2-28 - 1 Capsule of Cllofazimine every other day (50 mg) - 1 Tablet of Dapsone (50 mg)

FULL COURSE: 12 Blister Packs For Children younger than 10, the dose must be adjusted according to body weight. Information for the Patient – Counselling Points About leprosy ……… •

They will be cured of leprosy if they take the drugs in the blister packs as advised

•

They must complete a full course of treatment : 6 Blisters for PB patients and 12 Blisters for MB patients

•

The drugs stop the disease from spreading

•

Patients can lead normal lives. They can live at home, go to school, work, play, get married, have children, participate in social events.

Their treatment ……… •

The MDT blister packs are free of charge

•

They should keep the blister packs in a dry, safe and shady place and out of the reach of children

•

If the drugs are spoiled (changed colour, broken), the health worker will replace them

36

Possible problems…………. •

The medicines will turn their urine red and their skin darker.

•

Patients should not worry : both will return to normal once the treatment is completed

•

They must go immediately to a health centre if they have any problems (pain, fever, malaise, new lesions, muscle weakness).

•

They should return for a check-up after they complete their treatment

•

If they already have disabilities, tell them how to protect themselves from injuries

Important Points about MDT Safety •

MDT is very safe and effective in curing leprosy

•

MDT is safe during pregnancy

•

MDT is safe for patients being treated for tuberculosis (TB) as well as those who are HIVPositive

•

Rifampicin is common to the treatment of leprosy and TB and must be given in the doses required for TB

Treatment •

Give MDT free of charge to all leprosy patients

•

Help ensure that patients complete their treatment

•

Give patients enough blister packs to last until their next vi sit

•

Use accompanied MDT for all patients who find it difficult to visit the health centre regularly

•

If a person cured of leprosy presents new skin patches with definite loss of sensation, consider this as a case of relapse. Re-treat with appropriate MDT regimen

MDT Supplies Do not use MDT blister packs

•

beyond the expiry date

•

if the drugs are damaged, or have changed colour, or if a capsule is broken

•

keep MDT blister packs in a cupboard or a wooden box.

37

If MDT blister packs for children are not available, remove tablets from an adult pack of the appropriate dose.

Management of Reactions Cases 1. Leprosy reactions

Patients can develop reactions, which are part of the natural course of the disease. Reactions are not a side effect of MDT. They are the body’s response to leprosy and do not mean that the disease is becoming worse or that the treatment is not working.

2. Managing Reactions

If a patient has any of these symptoms, he or she must go immediately to a health centre for treatment. Reactions require urgent treatment with special medicines as they can lead to irreversible deformities.

Give aspirin or paracetamol to reduce pain and fever. Advise the patients to rest as that is essential.

3. Dose of Prednisolone

Maximum Dose of prednisolone is 1 mg per kg of body weight If you have a course of corticosteriods (e.g. prednisolone), please administer : 40 mg daily for weeks 1 and 2, 30 mg daily for weeks 3 and 4, 20 mg daily for weeks 5 and 6, 15 mg daily for weeks 7 and 8, 10 mg daily for weeks 9 and 10, 5 mg daily for weeks 11 and 12.

Prevention of Deformity and Ulcer Care Services Simple measures to prevent disabilities

38

Patients with insensitive hands or feet injure themselves without noticing it. These wounds can get infected and over time, lead to irreversible deformities. The patients with insensitive hands or feet should be advised as below : a) Inspect hand/ feet daily looking for blisters, warm spots, red spots and tender areas. b) Learn how to avoid injury

Hands:•

Use protective implements like gloves, towels, long sticks

•

Practice safe procedure while cooking

•

Bandage tool handles with cloth to make them safer

Feet:•

Walk slowly, avoid running

•

Do not stand at one place for long time

•

Do not walk long distances, rest in between

•

Use protective footwear – MCR

c) If skin has become hard & dry, keep hands/ feet soaked in water for 20 minutes. Apply oil over skin afterwards. Scrape off the callused skin. d) Do not use finger nails to remove nasal concretions.

39

Annexure 5 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS

Services and Standards at Community Health Centres (a) Eye Care Services

(i) (ii) (iii)

Basic Services: Diagnosis and Treatment of Common Eye Diseases Refraction Services Surgical Services including Cataract Surgery (by IOL implantation) at selected places (one per 5 lakh population)

(b) Physical Structure for Eye Care at CHC (i)

Refraction Room

(ii)

Eye OT with Eye Ward (number of beds dependent on workload)

(c) Equipment For IOL Surgery Operating Microscope A-Scan Biometer Keratometer Slit Lamp Auto Refractometer Flash Autoclave Streak Retinoscope Tonometers (Schiotz) Direct Ophthalmoscope For primary Eye Care & Vision Testing Tonometers (Schiotz) Direct Ophthalmoscope Illuminated Vision Testing Drum Trial Lens Sets with Trial Frames Snellen & Near Vision Charts Battery Operated Torch (2) Eye Ointments Atropine (1%) Local antibiotic: Framycetin/Gentamicin etc. Local antibiotic steroid ointment Ophthalmic Drops Xylocaine 4% (30ml) Local antibiotic: Framycetin/Gentamicin etc. Local antibiotic steroid drops Pilocarpine Nitrate 2%

40

Timolol 0.5% Homatropine 2% Tropicamide 1% Injections Xylocaine 2% (30 ml) Inj Hyalase (Hyaluronidase) Gentamycin Betamethasone/Dexamethasone Inj. Maracaine (0.5%) (For regoinal anesthesia) Inj. Adrenaline Ringer Lacate (540 ml) from reputed firm Surgical Accessories Gauze Green Shades Blades (Carbon Steel) Opsite surgical gauze (10x14 c.m.) Double needle Suture (commodity asstt. GOI ) Visco-elastics from reputed firm

(d) Human Resource s: 1. 2.

Eye Surgeon (trained in IOL Surgery) Ophthalmic Assistant

41

Annexure 6

INTEGRATED DISEASE SURVEILLANCE PROJECT

Services and Standards at Community Health Centres

(a) Services relating to Disease Surveillance:

(i) Laboratory services for diagnosis of Malaria, Tuberculosis, Typhoid and tests for detection of faecal contamination of water and chlorination level. Existing peripheral laboratories at the PHC level are capable of handling microscopic examination of sputum and blood smears and are currently undertaking this activity under TB and Malaria Control Programs. Typhoid can be diagnosed at the periphery using ‘Typhi Dot’ test, which can be performed easily and has established validity and reliability. Kits are available for detecting fecal contamination of water, which can be used at the periphery and these will be made available. Disease

Test

Tuberculosis

Sputum AFB smear

Malaria

Blood smear for Malaria

Typhoid

Rapid Diagnostic test (Typhi Dot)

Water Quality

Kit for chlorination test

Water Quality

Rapid

test

Kit

for

fecal

contamination (ii) Data management: CHC will function as peripheral surveillance unit and coallate, analyse and report information to District Surveillance Unit. In out-break situations, appropriate action will also be initiated.

42

(b) Physical Structure for Laboratory at CHC

Item 1

Marble/Stone Platform

Table

No.at CHC level Top

for

1

2 Wash-basins (Steel/Porcelain)

1

3 Water Tapes

1

4 Electric Fittings

As per requirement

5 Office Table

1

6 Office Chairs

3

7 Revolving Stools

2

8 Almirah (Steel/Wooden)

1

9 Wooden/Steel Racks

1

(c) Laboratory Equipment

Equipments 1 Binocular Microscope with immersion 2. Lancet 3. Ice box 4 Stool transport carrier 5. Test tube rack 6. Table top centrifuge 7. Refrigerator 8. Spirit lamp 9. Smear transporting box 10. Sterile leak proof containers

oil

(d) Laboratory Supplies

43

Supplies

1. 2. 3. 6. 7. 8. 9. 10. 11.

Clean slides Slide markers Gloves Transport medium (Cary Blair) Sterile test tubes Plastic vials Sterile cotton wool swabs Rapid Diagnostic Kit Typhoid Rapid test kit for faecal contamination Blood culture bottles with broth Zeil Neelsen Acid fast stain Aluminium Foil Cotton Sealing material

12. 13. 14. 15. 16.

17. Extra plastic vials transportation of serum 1. 2.

for

(e) Human Resources: Personnel trained in disease surveillance

Medical Officer Laboratory Technician

Medical Record Keeper /Data Entry Operator

44

Annexure 7

REFERRAL TRANSPORT MODEL Round the clock functional Ambulance / rural transportation – Harayana model

1.

An advertisement is placed in Local Newspaper for leasing of Ambulance by the CMO Office.

2.

Preference is given to Ex-Army Defense / Services personnel.

3.

Ambulance is given to the Driver by the CMO Office. No guarantee is required.

4.

Charges of transportation are fixed at Rs. 5/km.

5.

Driver is on a contract basis

6.

Driver is required to deposit 50 paise/km in CMO office a monthly basis. This money is kept for major repair.

7.

Driver gets Rs. 4.50/km. This would cover petrol, salary and minor repairs.

8.

Driver owns the Ambulance after 5 years.

Annexure 8

LIST OF EQUIPMENTS IN CHC

Standard Surgical Set - I (Instruments) FRU

45

1 Tray, instrument/dressing with cover, 310 x 200 x 600 mm-ss 1

1

2 Gloves surgeon, latex sterilizable, size 6 12

12

3 Gloves surgeon, latex sterilizable, 6-1/2 12

12

4 Gloves surgeon, latex sterilizable, size 7 12

12

5 Gloves surgeon, latex sterilizable, 7-1/2 12

12

6 Gloves surgeon, latex sterilizable, 8 12

12

7 Forceps, backhaus towel, 130 mm 4

4

8 Forceps, sponge holding, 228 mm 6

6

9 Forceps, artery, pean straight, 160 mm, stainless steel 4

4

10 Forceps hysterectomy, curved, 22.5 mm 4

4

11 Forceps, hemostatic, halsteads mosquito, straight, 125 mm-ss 6

6

12 Forceps, tissue, all/is 6x7 teeth, straight, 200 mm-ss 6

6

13 Forceps, uterine, tenaculum, 280 mm, stainless steel 1

1

14 Needle holder, mayo, straight, narrow jaw, 175 mm, ss 1

1

15 Knife-handle surgical for minor surgery # 3 1

1

16 Knife-handle surgical for major surgery # 4 1

1

17 Knife-blade surgical, size 11, for minor surgery, pkt of 5 3

3

18 Knife-blade surgical, size 15 for minor surgery, pkt of 5 4

4

19 Knife blade surgical, size 22, for major surgery, pkt of 5 3

3

20 Needles, suture triangular point, 7.3 cm, pkt of 6 2

2

21 Needles, suture, round bodied, 3/8 circle No. 12 pkt of 6 2

2

22 Retractor, abdominal, Deavers, size 3, 2.5 cm x 22.5 cm 1

1

23 Retactor, double-ended abdominal, Beltouis, set of 2 2

2

24 Scissors, operating curved mayo-blunt pointed 170mm 1

1

25 Retractor abdominal, Balfour 3 blade self-retaining 1

1

26 Scissors, operating, straight, blunt point, 170 mm 1

1

27 Scissors, gauze, straight, 230 mm, stainless steel 1

1

28 Suction tube, 225 mm, size 23 F 1

1

29 Clamp intestinal, Doyen, curved, 225 mm, stainless steel 2

2

30 Clamp intestinal, Doyen straight, 225 mm, stainless steel 2

2

31 Forceps, tissue spring type, 160 mm, stainless steel 2

2

32 Forceps , tissue spring type, 250 mm, stainless steel. 1

1

Standard Surgical Set - II 1. Forceps, tissue, 6 x 7 teeth, Thomas-Allis, 200 mm- ss 1

1

2. Forceps, backhaus towel, 130 mm, stainless steel 4

4

46

3. Syringe, anaesthetic (control), 10 ml, luer-glass 1

1

4. Syringe, hypodermic, 10 ml glass, spare for item 3 4

4

5. Needles, hypodermic 20G x 1-1/2” box of 12 1

1

6. Forceps, tissue, spring type, 145 mm, stainless steel 1

1

7. Forceps, tissue spring type 1 x 2 teeth, Semkins, 250 mm 1

1

8. Forceps, tissue spring type, 250 mm, stainless steel 1

1

9. Forceps, hemostat curved mosquito halsteads, 130 mm 6

6

10. Forceps, artery, straight pean, 160 mm, stainless steel 3

3

11. Forceps artery, curved pean, 200 mm, stainless steel 1

1

12. Forceps, tissue, Babcock, 195 mm, stainless steel 2

2

13. Knife handle for minor surgery No. 3 1

1

14. Knife blade for minor surgery No. 10, pkt of 5 8

8

15. Needle holder, straight narrow-jaw Mayo–Heger, 175 mm 1

1

16. Needle suture straight, 5.5 mm, triangular point, pkt of 6 2

2

17. Needle, Mayo, ½ circle, taper point, size 6, pkt of 6 2

2

18. Catheter urethral Nelaton solid-tip one-eye 14 Fr 1

1

19. Catheter urethral Nelaton solid-tip one-eye 16 Fr 1

1

20. Catheter urethral Nelaton solid-tip one-eye 18 Fr 1

1

21. Forceps uterine tenaculum duplay dbl-cvd, 280 mm 1

1

22. Uterine elevator (Ranathlbod), stainless steel 1

1

23. Hook, obstetric, Smellie, stainless steel 1

1

24. Proctoscope Mcevedy complete with case 1

1

25. Bowl, sponge, 600 ml, stainless steel 1

1

26. Retractor abdominal Richardson-Eastman, dbl-ended, set 2 1

1

27. Retractor abdominal Deaver, 25 mm x 3 cm, stainless steel 1

1

28. Speculum vaginal bi-valve graves, medium, stainless steel 1

1

29. Scisssors ligature, spencer straight, 130 mm, stainless steel

1

30. Scissors operating straight, 140 mm, blunt/blunt ss 1

1

31. Scissors operating curved, 170 mm, blunt/blunt ss 2

2

32. Tray instrument curved, 225 x 125 x 50 mm, stainless steel 1

1

33. Battery cells for item 24 2

2

IUD Insertion Kit 1 Setal sterilization tray with cover size 300 x 220 x 70 mm, S/S, Ref IS: 3993 1 2 Gloves Surgeon, latex, size 6-1/2 Ref. 4148 6

1 6

47

3 Gloves surgeon latex, size 7-1/2 Ref. 4148 6

6

4 Bowl, metal sponge, 600 ml, Ref. IS: 5782 1

1

5 Speculum vaginal bi-valve cusco's graves small ss 1

1

6 Forceps sponge holding, straight 228 MMH Semken 200 mm 1

1

7 Sound uterine simpson, 300 mm graduated UB 20 mm 1

1

8 Forceps uterine tenaculum duplay DBL-CVD, 280 mm 1

1

9 Forceps tissue - 160 mm 1

1

10 Anterior vaginal wall retractor stainless 1

1

11 Torch without batteries 1

1

12 Gloves surgeon, latex, size 7, Ref: 4148 6

6

13 Gloves surgeon, latex size 6 Ref. IS: 4148 6

6

14 Battery dry cell 1.5 V 'D' Type for Item 7G 1

1

15 Speculum vaginal bi-valve cusco's/Grea Ves Medium ss 1

1

16 Forceps artery, straight, Pean, 160 mm 1

1

17 Scissors operating, straight, 145 mm, Blunt/Blunt 1

1

18 Forceps uterine vulsellum curved, Museux, 240 mm 1

1

19 Speculum vaginal double-ended sime size #3 1

1

S. No. Item Description Qty.

CHC Standard Surgical Set – III Tray, instrument/dressing with cover, 310 x 195 x 63 mm 1

1

Forceps, backhaus towel, 130 mm, stainless steel 4

4

Forceps, hemostat, straight, Kelly, 140 mm, stainless steel 4

4

Forceps, hemostat, curved, Kelly, 125mm, stainless steel 2

2

Forceps, tissue Allis, 150 mm, stainless steel, 4 x 5 teeth 2

2

Knife handle for minor surgery No. 3 1

1

Knife blade for minor surgery, size 11, pkt of 5 10

10

Needle hypodermic, Luer 22G x 11/4", box of 12 1

1

Needle hypodermic, Luer 250G x 3/4", box of 12 1

1

Needle, suture straight 5.5 cm, triangular point, pkt of 6 2

2

Needle, suture, Mayo ½ circle, taper point No. 6, pkt of 6 2

2

Scissors, ligature, angled on flat, 140 mm, stainless steel 1

1

Syringe anaesthetic control, Luer - 5 ml, glass 4

4

48

Syringe 5 ml, spare for item 13 4

4

Sterilizer, instrument 200 x 100 x 60 mm with burner ss 1

1

Syringe, hypodermic, Luer 5 ml, glass 4

4

Forceps, sterilizer, Cheatle, 265 mm, stainless steel 1

1

Normal Delivery Kit Trolley, dressing carriage size 76C, long x 46 cm wide and 84 cm high. Ref. IS 4769/1968 1 Towel, trolley 84 cm x 54 cm 2

1

Gown, operation, cotton 1

1

Cap. operation, surgeon's 36 x 46 cm 2

2

Gauze absorbent non-sterile 200 mm x 6 m as per IS: 171/1985 2

2

Tray instrument with cover 450 mm (L) x 300 mm (W) x 80 mm (H) 1

1

Macintosh, operation, plastic 2

2

Mask, face, surgeon's cap of rear ties: B) Beret type with elastic hem 2

2

Towel, glove 3

3

Cotton wool absorbent non-sterilize 500G 2

2

Drum, sterilizing cylindrical - 275 mm Dia x 132 mm, ss as per IS: 3831/1979

2

2

2 Table instrument adjustable type with tray ss 1

1

Item Description Qty. Standard Surgical Set – IV Vaccum extractor, Malastrom 1

1

Forceps obstetric, Wrigley’s, 280 mm, stainless steel 1

1

Forceps, obstetric, Barnes-Neville, with traction, 390mm 1

1

Forceps, sponge holding, straight 228 mm, stainless steel 4

4

Forceps, artery, Spencer-Wells, straight, 180mm-ss 2

2

Forceps, artery, Spencer-Wells, straight, 140mm-ss 2

2

Holder, needle straight, Mayo-Hegar, 175 mm-ss 1

1

Scissors, ligature, Spencer, 130 mm, stainless steel 1

1

Scissors, episiotomy, angular, Braun, 145 mm, stainless steel 1

1

Forceps, tissue, spring-type, 1 x 2 teeth, 160 mm-ss 1

1

Forceps, tissue, spring-type, serrated ups, 160mm-ss 1

1

Catheter, urethral, rubber, Foley’s 14 ER 1

1

Catheter, urethral, Nelaton, set of five (Fr 12-20) rubber 1

1

Forceps, backhaus towel -130 mm-ss 4

4

49

Speculum, vaginal, Sim’s, double-ended # 3-ss 1

1

Speculum, vaginal, Hamilton-Bailey 1

1

Item Description Qty. Standard Surgical Set – V Forceps, obstetric, Neville-Barnes, W/traction 390 mm 1

1

Hook, decapitation, Braun, 300 mm, stainless steel 1

1

Hook, crochet, obstetric 300 mm, Smellie, stainless steel 1

1

Bone, forceps, Mesnard 280 mm, stainless steel 4

4

Perforator, Smellie, 250 mm, stainless steel 1

1

Forceps, cranial, Gouss, straight, 295 mm-ss 1

1

Cranioclast, Braun, stainless steel, 365 mm long 1

1

Scissors ligature Spencer 130 mm, stainless steel 1

1

Forceps sponge holding, 22.5 cm straight – ss 1

1

Forceps, tissue, spring-type, 1 x 2 teeth, 160 mm, stainless steel 1

1

Forceps, tissue, spring-type, serrated tips, 160 mm-ss 1

1

Forceps, artery, Spencer–Wells, straight, 180 mm-ss 2

2

Forceps, artery, Spencer-Wells, straight, 140 mm-ss 2

2

Forceps, scalp flap, Willet’s 190 mm –ss 4

4

Forceps, Vulsellum, duplay double curved, 280 mm-ss 4

4

Forceps, Vulsellum, duplay double curved, 240 mm-ss 1

1

Catheter, urethral, 14 Fr. solid tip, one eye, soft rubber 3

3

Holder, needle, Mayo-Hegar, narrow jaw, straight, 175 mm-ss 1

1

Speculum vaginal bi-valve, Cusco-medium, stainless steel 1

1

Speculum, vaginal sim’s double-ended, size # 3-ss 1

1

Forceps, backhaus towel, 130 mm, stainless steel 4

4

Item Description Qty. Standard Surgical Set – VI Forceps, sponge holding, straight, 225 mm, stainless steel 4

4

Speculum, vaginal, Sim’s double-ended size # 3 – ss 1

1

Speculum, vaginal, weighted Auvard, 38 x 75 mm blade – ss 1

1

Forceps, tenaculum, Teale’s, 230 mm-ss x 3 x 4 2

3x42

Sound, uterine, Simmpson, 300 mm with 200 mm graduations 1

1

Dilator, uterine, double - ended hegar, set of 5 – ss 1

1

Curette, uterine, sim’s blunt, 26 cm x 11 mm size # 4-ss 2

2

Curette, uterine, sim’s sharp, 26 cm x 9 mm size # 3-ss 2

2

50

Forceps, artery, Spencer-Well’s straight, 140 mm-ss 1

1

Forceps, tissue, spring-type, serrated tips, 160 mm-ss 1

1

Forceps, ovum, Krantz, 290 mm, stainless steel 1

1

Item Description Qty. Equipment for Anaesthesia Facemask, plastic w/rubber cushion & headstrap, set of 4 4

4

Airway Guedel or Berman, autoclavable rubber, set of 6 2

2

Laryngoscope, set with infant, child, adolescent blades 3

3

Catheter, endotracheal w/cuff, rubber set of 4 3

3

Catheter, urethral, stainless steel, set of 8 in case 2

2

Forceps, catheter, Magill, adult and child sizes, set of 2 1

1

Connectors, catheter, straight/curved, 3, 4, 5 mm (set of 6) 3

3

Cuffs for endotracheal catheters, spare for item 4 4

4

Breathing tubes, hoses, connectors for item 1, anti-static 4

4

Valve, inhaler, chrome-plated brass, Y-shape 3

3

Bag, breathing, self inflating, anti-static rubber, set of 4 2

2

Vaporiser, halothane, dial setting 2

2

Vaporiser, ether or methoxyflurane, wick type 2

2

Intravenous set in box 6

6

Needle, spinal, stainless set of 4 2

2

Syringe, anesthetic, control 5ml Luer mount glass 2

2

Cells for item 3 2

2

Qty. Equipment for Neo-natal Resuscitation Catheter, mucus, rubber, open ended tip, size 14FR 2

2

Catheter, nasal, rubber, open tip, funnel end, size 8Fr 2

2

Catheter, endotracheal, open tip, funnel end rubber, 12Fr 3

3

Stilette, curved, for stiffening tracheal catheter SS 1

1

Catheter, suction, rubber, size 8Fr 3

3

Laryngoscope, infant, w/three blades and spare bulbs. 1

1

Lateral mask, with ventillatory bag, infant size 2

2

Resuscitator, automatic, basinet type 1

1

Lamp, ultra-violet (heat source) with floor stand 1

1

Cells for item 6 (Laryngoscope) 2

2

Oxygen Cylinders

1

Nasal Prongs

5

51

Thermometers

5

Infantometer: Measuring range 33-100 cm

2

Stadiometer: Measuring range 60-200 cm

1

Phototherapy unit

1

Radiant Warmers

2

Dextrosticks

100 sticks

Nebulisers / MDI

1

IV canulas (22G and 24G)

100 each

Scalp vein set No. 22 and 24

100 each

Nasogastric tube (8, 10, 12 FG)

20

Oropharyngeal airway (000-4 Guedel size) Plastic / disposable syringes including tuberculin

100

IV infusion sets (adult and pediatric)

100

scription Qty. Materials Kit for Blood Transfusion Bovine albumin 20% testing agent, box of 10 x 5 ml vials 5

5

Centrifuge, angle head for 6 x 15 ml tubes, 240 volt 1

1

Bath, water, serological, with racks, cover, thermostate, 240 v 1

1

Pipette, volumetric, set of six 1 ml/2 ml/3 ml/5 ml/10 ml/20 ml 1

1

Test-tube without rim 75 x 12 mm HRG 12

12

Test-tube without rim 150 x 16 mm, HRG 12

12

Cuff, sphygmomanometer, set of two sizes – Child/Adult 1

1

Needle, blood collection disposable, 17G x 1-1/3 box of 100 1

1

Ball, donor squeeze, rubber, dia, 60 mm 1

1

Forceps, artery, Spencer-Wells, straight 140 mm, stainless steel 1

1

Scissors, operating, straight 140 mm, blunt/jpoints, ss 1

1

CPDA anti-coagulent, pilot bottle 350 ml for collection 20

20

Microscope, binocular, inclined, 10 x 40 x 100 x magnificant 1

1

Illuminator for item 14 (microscope) 1

1

Slides, microscope, plain 25 x 75 mm, clinical, box of 100 1

1

Equipment for Operation Theatre Diathermy machine Dressing drum all sizes Lamps shadowless:

52

Ceiling lamp Portable type Steriliser Suction Apparatus Stand with wheel for single basin Table operation, hydraulic: Major Minor Trolley for patients Trolley for instruments X-ray view box Wheel chairs

Equipment for Labour Room Aprons rubber Cradles baby Wheel chair Cabinet Instrument Dressing drum Shadowless lamps Table for Obstetric labour Examination Trolley for Patients Dressing Torch (flash light) Trays Vacuum Extractor Weighing machine baby Wheel chairs

Equipment for Radiology

Aprons lead rubber Diagnostic X-ray Unit 200/300mA with automatic device Dark room accessories

53

Dark room timer Film clips Lead sheets X-ray view box X-ay prot ection screen X-ray film processing tank

Equipments under National Health Programmes (as listed under each NHP), Cold storage facility under Immunisation Programme and Blood Storage equipment as at Annexure – 10.

54

Annexure 9

LIST OF ESSENTIAL DRUGS FOR CHC Name of the Drug

Route

of

Strength

administration/ dosage form 1

Oxygen

Inhalation

2

Lignocaine Hydrochloride

Topical Forms

2-5%

Injection

1-2%

Tablets

2 mg, 5 mg, 10 mg

Injection

5 mg / ml

Tablets

75mg, 100 mg 300

3

4

Diazepam

Acetyl Salicylic Acid

mg 350 mg 5

Ibuprofen

Tablets

200 mg, 400 mg

6

Paracetamol

Injection

150 mg / ml

Syrup

125 mg / 5ml

Tablets

500 mg

7

Pentazocine Lactate

injection

30 mg/ ml

8

Chloroquine Phosphate

Tablets

150 mg

Injection

40 mg/ml

Syrup

50 ml/5 ml

9

Adrenaline bititrate

Injection

1mg/ml

10

Chlorpheniramine Maleate

Tablets

4 mg

11

Prednisolone

Tablets

5 mg, 10 mg

12

Promethazine HCL

13

Phenobarbitone

Tablets

30 mg. 60 mg

Injection

200 mg / ml

Capsules or Tablets

50 mg,100 mg

Syrup

25 mg / ml

14

Phenytoin Sodium

Injection 15

16

Albendazole

Amoxicillin Powder

50 mg / ml

Tablets

400 mg

Suspension

200 mg/ 5 ml

for suspension

125 mg / 5 ml

Capsules

250 mg 500 mg

55

17

Ciprofloxacin Hydrochloride

Tablets

250 mg,500 mg

18

Co-Trimoxazole

Tablets

40 + 200 mg 80 + 400 mg

Suspension

40 +200 mg / 5 ml

19

Norfloxacine

Tablet

400 mg

20

Doxycycline

Capsules

100 mg

21

Metronidazole

Tablets

200 mg,400 mg

22

Clotrimazole

Pessaries

100 mg, 200 mg

Gel

2%

23

Sulfadoxine +Pyrimethamine

Tablets

500 mg +25 mg

24

Ferrous Salt

Tablets

60 mg

Oral solution

25 mg

25

Folic Acid

Tablets

1 mg, 5 mg

26

Isosorbide Mononitrate/Dinitrate

Tablets

10 mg, 20 mg

27

Amlodipine

Tablets

2.5 mg, 5 mg,10 mg

28

Digoxin

Tablets

0.25 mg

Injection

0.25 mg / ml

29 30

Benzoic Acid +Salicylic Acid Miconazole

Elixir

0.05 mg / ml

Ointment or Cream

6% + 3%

Ointment or Cream

2%

31

Neomycin +Bacitracin

Ointment

32

Silver Sulphadiazine

Cream

33

Benzyl Benzoate

Lotion

34

Acriflavin+Glycerin

Solution

35

Gentian Violet

Paint

0.5%, 1%

36

Hydrogen Peroxide

Solution

6%

37

Povidone Iodine

Solution

5%, 10%

38

Bleaching Powder

Powder

39

Potassium Permanganate

Crystals for solution

40

Furosemide

Injection,

10 mg/ ml,

Tablets

40 mg

41

42

Aluminium Hydroxide + Magnesium

Tablet

Hydroxide

Suspension

Domperidone

Tablets Syrup

43

Local

Anaesthetic,Astringent

Antiinflammatory Medicine

and

5 mg + 500 IU 1% 25%

10 mg 1 mg / ml

Ointment /suppository

56

Antiinflammatory Medicine 44

Dicyclomine Hydrochloride

/suppository Tablets Injection

10 mg 10 mg / ml

45

Oral Rehydration Salts

Powder for solution

As per IP

46

Dexamithasone sodium

injection

4 mg/ml

47

Ciprofloxacin Hydrochloride

Drops/Ointment

0.3%

48

Tetracycline Hydrochloride

Ointment

1%

49

Alprozolam

Tab

0.25 mg

50

Salbutamol Sulphate

Tablets

2 mg, 4 mg

Syrup

2 mg / 5 ml

Inhalation

100 mg / dose

51

Etophyline anhydrous

Injection

84.7 mg/ml

52

Glucose

Injection

5% isotonic 50% hypertonic

53

Glucose with Sodium Chloride

54

Normal Saline

Injection

55

Ringer Lactate

Injection

56

Plasma volume expander

Injection

57

Water for Injection

Injection

2 ml, 5 ml,10 ml

58

Ascorbic Acid

Tablets

100 mg, 500 mg

59

Calcium salts

Tablets

250 mg, 500 mg

60

Multivitamins(As per Schedule V)

Injection

5% + 0.9% 0.9%

Tablets

61

Atenlol

Tablets

50 mg

62

Floxitin

Tablets

20 mg

63

Amitryptiline Hcl

Tablets

25 mg

64

Bisacodyl

Tablets

05 mg

65

General Anaesthetic drugs

66

Higher antibiotics

67

Tinidazole

Tablets

68

Daonil

Tablets

69

Haloperidol

Tablets

70

Sulpacetamide eye drops

71

IV fluids (Ringer’s lactate, normal saline, N/5 in 5% Dextrose, 10% Dextrose)

57

Other Injections:

S. No. 1. 2. 3. 4. 5. 6. 7. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Injections Cryst. Penicillin Procaine Penicillin Benz. Penicillin (1.2) Inj. Eptoin Inj. Crocin Inj. Ampicillin Inj. Gentamicin Inj. Soda Bicarb Inj. Calcium Gluconate Inj. KCI Inj. Adrenaline Inj. Atropine Inj. Buscopan Inj. Hydrocortisone Inj. Dexamethasone Inj. Syniocinon Inj. Methergin Inj. Duvadilon Inj. Deriphyllin Inj. Aminpphyllin Inj. Salsol Inj. Chlormycetin Inj. Manitol Inj. Chloroquine Inj. Pethidine Inj. Fortwin Inj. Chlorpromazine Inj. Choloroquine Inj. Phenergan Inj. Phenobarbitone Inj. Pheniramine (Avil) Inj. Dextrose (10%) Inj. Diazepam Inj. Sodium bicarbonate Inj. Dopamine Inj. Chloramphenicol Inj. Cefotaxime / Ceftriaxone Inj. Salbutamol respiratory solution Inj. Salbutamol MDI Inj. Aminophylline

-

Drug under various National Health Programmes (as listed under each NHP)

-

Vaccines as under Immunization Programme

58

LIST OF AYURVEDIC MEDICINES FOR CHCs 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54.

Sanjivani Vati Godanti Mishran AYUSH-64 Lakshmi Vilas Rasa (Naradeeya) Khadiradi Vati Shilajatwadi Louh Swas Kuthara rasa Nagarjunabhra rasa Sarpagandha Mishran Punarnnavadi Mandura Karpura rasa Kutajaghan Vati Kamadudha rasa Laghu Sutasekhar rasa Arogyavardhini Vati Shankha Vati Lashunadi Vati Kankayana Vati Agnitundi Vati Vidangadi louh Brahmi Vati Sirashooladi Vajra rasa Chandrakant rasa Smritisagara rasa Kaishora guggulu Simhanad guggulu Yograj guggulu Gokshuradi guggulu Gandhak Rasayan Rajapravartini Vati Triphala guggulu Saptamrit Louh Kanchanara guggulu Ayush Ghutti Talisadi Churna Panchanimba Churna Avipattikara Churna Hingvashtaka Churna Eladi Churna Swadishta Virechan Churna Pushyanuga Churna Dasanasamskara Churna Triphala Churna Balachaturbhadra Churna Trikatu Churna Sringyadi Churna Gojihwadi kwath Churna Phalatrikadi kwath Churna 54.Maharasnadi kwath Churna Pashnabhedadi kwath Churna Dasamoola Kwath Churna Eranda paka Haridrakhanda Supari pak

59

55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

Soubhagya Shunthi Brahma Rasayana Balarasayana Chitraka Hareetaki Amritarishta Vasarishta Arjunarishta Lohasava Chandanasava Khadirarishta Kutajarishta Rohitakarishta Ark ajwain Abhayarishta Saraswatarishta Balarishta Punarnnavasav Lodhrasava Ashokarishta Ashwagandharishta Kumaryasava Dasamoolarishta Ark Shatapushpa (Sounf) Drakshasava Aravindasava Vishagarbha Taila Pinda Taila Eranda Taila Kushtarakshasa Taila Jatyadi Taila/Ghrita Anu Taila Shuddha Sphatika Shuddha Tankan Shankha Bhasma Abhraka Bhasma Shuddha Gairika Jahar mohra Pishti Ashwagandha Churna Amrita (Giloy) Churna Shatavari Churna Mulethi Churna Amla Churna Nagkesar Churna Punanrnava Churna Dadimashtak Churna Chandraprabha Vati. Dhanwantara Taila Balaswagandhadi Taila Mahanarayana Taila Sahacharadi Taila Ksheerabala Taila Kaseesadi Taila Kolakulatthadi Udvarthana Churna Jatamayadi Udvarthana Churna Upanaha Churna Shadpala Ghrita

60

111. 112. 113. 114. 115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125.

Panchthiktha Guggulu Ghrita Panchagavya Ghrita Madanapippali Churna Saindhava Lavana Madhu Pippali Churna Shuddha Ghrita Trivrit Leha Dashmoola or Ransnadi Kwath Churna Manibhadra Guda Gandharvahastadi Kwath Churna Balaguluchyadi Kwath Churna Aragwadadi Kwath Churna Pure Ghrita Icchabhedi Rasa

LIST OF UNANI MEDICINES FOR CHCs 1. Arq-e-Ajeeb 2. Arq-e-Gulab 3. Arq-e-Kasni 4. Arq-e-Mako 5. Barshasha 6. Dawaul Kurkum Kabir 7. Dawaul Misk Motadil Sada 8. Habb-e-Aftimoon 9. Habb-e-Bawasir Damiya 10. Habb-e-Bukhar 11. Habb-e-Dabba-e-Atfal 12. Habb-e-Gule Pista 13. Habb-e-Hamal 14. Habb-e-Hilteet 15. Habb-e-Hindi Qabiz 16. Habb-e-Hindi Sual 17. Habb-e-Hindi Zeeqi 18. Habb-e-Jadwar 19. Habb-e-Jawahir 20. Habb-e-Jund 21. Habb-e-Kabid Naushadri 22. Habb-e-karanjwa 23. Habb-e-Khubsul Hadeed 24. Habb-e-Mubarak 25. Habb-e-Mudirr 26. Habb-e-Mumsik 27. Habb-e-Musaffi 28. Habb-e-Nazfuddam 29. Habb-e-Nazla 30. Habb-e-Nishat 31. Habb-e-Raal 32. Habb-e-Rasaut 33. Habb-e-Shaheeqa 34. Habb-e-Shifa 35. Habb-e-Surfa 36. Habb-e-Tabashir 37. Habb-e-Tankar

61

38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93.

Habb-e-Tursh Mushtahi Itrifal Shahatra Itrifal Ustukhuddus Itrifal Zamani Jawahir Mohra Jawarish Jalinoos Jawarish Kamooni Jawarish Mastagi Jawarish Tamar Hindi Khamira Gaozaban Sada Khamira Marwareed Kushta Marjan Sada Laooq Katan Laooq Khiyarshanbari Laooq Sapistan Majoon Arad Khurma Majoon Dabeedulward Majoon Falasifa Majoon Jograj Gugal Majoon Kundur Majoon Mochras Majoon Muqawwi-e-Reham Majoon Nankhwah Majoon Panbadana Majoon Piyaz Majoon Seer Alwikhani Majoon Suhag Sonth Majoon Suranjan majoon Ushba Marham Hina Marham Kafoor Marham Kharish Marham Quba Marham Ral Safaid Qurs Aqaqia Qurs Dawaul Shifa Qurs Deedan Qurs Ghafis Qurs Gulnar Qurs Habis Qurs Kafoor Qurs Mulaiyin Qurs Sartan Kafoori Qurs Zaranbad Qurs Ziabetus Khaas Qurs Ziabetus Sada Qurs-e-Afsanteen Qurs-e-Sartan Qutoor-e-Ramad Raughan Baiza-e-Murgh Raughan Bars Raughan Kahu Raughan Kamila Raughan Qaranful Raughan Surkh Raughan Turb

62

94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. 115. 116.

Roghan Luboob Saba Roghan Malkangni Roghan Qust Safoof Amla Safoof Chutki Safoof Dama Haldiwala Safoof Habis Safoof Muqliyasa Safoof Mustehkam Dandan Safoof Naushadar Safoof Sailan Safoof Teen Sharbat Anjabar Sharbat Buzoori Motadil Sharbat Faulad Sharbat Khaksi Sharbat Sadar Sharbat Toot Siyah Sharbat Zufa Sunoon Mukhrij-e-Rutoobat Tiryaq Nazla Tiryaq pechish Zuroor-e-Qula

LIST OF SIDDHA MEDICINES FOR CHCs 1.

Amai otu parpam

2.

Amukkarac curanam

-For general debility, insomnia

3

Anna petic centuram

-For anaemia

4.

Antat Tailam

5.

Appirakac centuram

- Diabetes mellitus

6.

Arakkut Tailam

- Headache and sinus infection

7.

Arumukac Centuram

- Arthritis

8.

Atotataik kuti nir

- cough and cold

9.

Atatotai manappaku

10.

-For diarrhoea in children and indigestion

- For febrile convulsions

- cough and cold

Atatotai nei

- cough and wheeze

11.

Aya jampirac karpam

- anaemia

12.

Aya Kantac centuram

- aneamia

13.

Canku parpam

- anti allergic

14.

Cantamarutac Centuram

- arthritis

15.

Canta cantirotayam

- fevers and jaundice

16.

Carapunka Vilvati ilakam

- nervine tonic

17.

Cati Campirak Kulampu - Nausea and vomiting

18.

Cempu Parpam

19.

Cilacattu Parpam

- peptic ulcer - Urinary infection, white discharge

63

20.

Cintil Curanam

- diabetes mellitus

21.

Ciropara Nivarana Tailam

- Headache and sinus

22.

Cirra Muttit Tailam

- neuritis, uterine problems

23.

Civanar Amirtam

- anti allergic, bronchial asthma

24.

Comput Tinir

- indigestion, loss of appetite

25.

Cukkut Tailam

26.

Cuvacakkutori mathirai - asthma and cough

27.

Elatic curanam

- allergy, fever in primary complex

28.

Ilaku Vitamuttit Tailam

- hemiplegia

29.

Impural Ilakam

- bleedings

30.

Impural Vatakam

31.

Incic Curanam

32.

Iraca Kanti Meluku

- skin infections, venereal infections.

33.

Iti Vallati

- venereal ulcers

34.

Kaiyan Tailam

35.

Kantaka Racayanam

36.

Kapa Curak Kutinir

- fevers

37.

Karappan Tailam

- eczema

37.

Karunai Ilakam

39.

Kasturik karuppu

40.

Kauri Cintamanic Centuram – liver disorders, fever, fistula

41.

Kecari Ilakam

- dropsy, amoebic dysentery

42.

Kilanellit Tailam

- jaundice, giddiness, neuritis

43.

Kilincil Meluku

- cracks on the heel and sole

44.

Korocanai mattirai

- sinus, fits.

45.

Kunkiliya parpam

- urinary infection, white discharge

46.

Kunkumappu Mattirai

47.

Kunkiliya Vennay

48.

Kunmak Kutori

49.

Kuntarikat Tailam

50.

Man Kompup Parpam

- chest pain

51.

Manturati Ataik Kutinir

- anaemia

52.

Mattan Tailam

- ulcers ,carbuncle and gangrene

53.

Matulai Manappaku

54.

Mayanat Tailam

- swelling, inflammation

55.

Mayilirakatic Curanam

- hiccup

56.

Mekanatak Kulikai

- headache and earache

- blood vomiting - indigestion, flatulence

- cough with expectoration - skin diseases and urinary infections.

- piles - fever, cough, allergic bronchitis

- peptic ulcer, habitual constipation - external application for piles and scalds - peptic ulcer - swelling and inflammation

- nausea, vomiting, anaemia

- constipation

64

57.

Murukkan Vitai Mattirai - intestinal worms

58.

Muttuc cippi Parpam

59.

Naciroka Nacat Tailam - nasal problems

60.

Naka Parpam

61.

Nantukkal Parpam

62.

Nattai Parpam

- bleeding piles

63.

Nellikkai Ilakam

- tonic

64.

Neruncik Kutinir

- diuretic

65.

Nilavakaic Curanam

- constipation

66.

Nila Vempuk Kutinir

- fever

67.

Noccit Tailam

68.

Omat Tinir

- indigestion

69.

Palacancivi mattirai

- fever in children, indigestion

70.

Palakarai Parpam

- anti allergic

71.

Panca Lavana Parpam - hyper acidity

72.

Parankip pattaic Curanam

73.

Parankip Pattai Iracayanam – skin diseases

74.

Parankip Pattaip Patankam

75.

Patikara parpam

76.

Pattuk karuppu

- DUB, painful menstruation

77.

Pavala Parpam

- cough and fever

78.

Peranta Parpam No.1

- fits

79.

Pinacat tailam

- sinus

80.

Pirami Ney

- nervine tonic

81.

Pirammananta pairavam

- fevers

82.

Punkat Tailam

83.

Talampu mattirai

- toxic fever

84.

Talicati Vatakam

- cough

85.

Tayirc Cuntic Curanam - diarrhea, used as ORS

86.

Terran kottai Ilakam

- tonic, used in bleeding piles

87.

Tiripalaic Curanam

- styptic and tonic

88.

Tipplili Iracayanam

- cough

89.

Uluntut Tailam

90.

Vacanta Kucumakaram - fever, cough, and cold in children

91.

Veti Anna Petic Centuram

- dropsy

92.

Vilvati Ilakam

- tonic

93.

Visnu Cakkaram

- pleurisy

- diarrhea in children

- diuretic - diuretic

- sinus

- skin diseases

- skin diseases - urinary infection, stomatitis

- injury and ulcers

- muscular atrophy, deafness

65

Patent & Proprietary Drug 1.

777 Oil

-

for Psoriasis

LIST OF HOMEOPATHY MEDICINES FOR CHCs S.No

Name of Medicine

Potency

1 Abrotanum

30

2 Abrotanum

200

3 Absinthium

Q

4 Aconite Nap.

6

5 Aconite Nap.

30

6 Aconite Nap.

200

7 Aconite Nap.

1M

8 Actea Racemosa

30

9 Actea Racemosa

200

10 Aesculus Hip

30

11 Aesculus Hip

200

12 Aesculus Hip

1M

13 Agaricus musca.

30

14 Agaricus musca

200

15 Allium cepa

6

16 Allium cepa

30

17 Allium cepa

200

18 Aloe soc.

6

19 Aloe soc.

30

20 Aloe soc.

200

21 Alumina

30

22 Alumina

200

23 Ammon Carb

30

24 Ammon Carb

200

25 Ammon Mur

30

26 Ammon Mur

200

27 Ammon Phos

30

28 Ammon phos

200

29 Anacardium Ori.

30

30 Anacardium Ori.

200

31 Anacardium Ori.

!M

32 Angustura vera

Q

33 Anthracinum

200

34 Anthracinum

1M

35 Antim Crud

30

36 Antim Crud

200

66

37 Antim Crud 38 Name of Medicine 39 Antimonium Tart

!M Potency 3X

40 Antimonium Tart

6

41 Antimonium Tart

30

42 Antimonium Tart

200

43 Apis mel

30

44 Apis mel

200

45 Apocynum Can

Q

46 Apocynum Can

30

47 Arg. Met

30

48 Arg Met.

200

49 Arg. Nit.

30

50 Arg. Nit.

200

51 Arnica Mont.

Q

52 Arnica Mont

30

53 Arnica Mont

200

54 Arnica Mont

!M

55 Arsenicum Alb.

6

56 Arsenicum Alb.

30

57 Arsenicum Alb.

200

58 Arsenicum Alb.

1M

59 Aurum Met.

30

60 Aurum Met.

200

61 Bacillinum

200

62 Bacillinum

1M

63 Badiaga

30

64 Badiaga

200

65 Baptisia Tinct.

Q

66 Baptisia Tinct

30

67 Baryta Carb.

30

68 Baryta Carb.

200

69 Baryta Carb.

1M

70 Baryta Mur.

3X

71 Belladonna

30

72 Belladonna

200

73 Belladonna

1M

74 Bellis Perennis

Q

75 Bellis Perennis

30

76 Benzoic Acid

30

77 Benzoic Acid

200

78 Berberis Vulgaris

Q

67

79 Berberis Vulgaris

30

80 Berberis Vulgaris

200

81 Blatta Orientalis

Q

82 Blatta Orientalis

30

83 Blumea Odorata

Q

84 Borax

30

85 Bovista

30

86 Bromium

30

87 Bryonia Alba

3X

88 Bryonia Alba

6

89 Bryonia Alba

30

90 Bryonia Alba

200

91 Bryonia Alba

1M

92 Bufo rana

30

93 Carbo veg

30

94 Carbo veg

200

95 Cactus G.

Q

96 Cactus G.

30

97 Calcarea Carb

30

98 Calcarea Carb

200

99 Calcarea Carb

1M

100 Calcarea Fluor

30

101 Calcarea Fluor

200

102 Calcarea Fluor

1M

103 Calcarea Phos

30

104 Calcarea Phos

200

105 Calcarea Phos

1M

106 Calendula Off.

Q

107 Calendula Off

30

108 Calendula Off

200

109 Camphora

6

110 Camphora

200

111 Cannabis Indica

6

112 Cannabis Indica

30

113 Cantharis

Q

114 Cantharis

30

115 Cantharis

200

116 Capsicum

30

117 Capsicum

200

118 Carbo Animalis

30

119 Carbo Animalis

200

120 Carbolic Acid

30

68

121 Carbolic Acid

200

122 Carduus Mar

Q

123 Carduus Mar

6

124 Carduus Mar

30

125 Carcinosinum

200

126 Carcinosinum

!M

127 Cassia sophera

Q

128 Caulophyllum

30

129 Caulophyllum

200

130 Causticum

30

131 Causticum

200

132 Causticum

!M

133 Cedron

30

134 Cedron

200

135 Cephalendra Indica

Q

136 Chamomilla

6

137 Chamomilla

30

138 Chamomilla

200

139 Chamomilla

!M

140 Chelidonium

Q

141 Chelidonium

30

142 Chin Off.

Q

143 Chin Off

6

144 Chin Off

30

145 Chin Off

200

146 Chininum Ars

3X

147 Chininum Sulph

6

148 Cicuta Virosa

30

149 Cicuta Virosa

200

150 Cina

Q

151 Cina

3X

152 Cina

6

153 Cina

30

154 Cina

200

155 Coca

200

156 Cocculus Indicus

6

157 Cocculus Indicus

30

158 Coffea Cruda

30

159 Coffea Cruda

200

160 Colchicum

30

161 Colchicum

200

162 Colocynthis

6

69

163 Colocynthis

30

164 Colocynthis

200

165 Crataegus Oxy

Q

166 Crataegus Oxy

3X

167 Crataegus Oxy

30

168 Crataegus Oxy

200

169 Crotalus Horridus

200

170 Croton Tig.

6

171 Croton Tig.

30

172 Condurango

30

173 Condurango

200

174 Cuprum met.

30

175 Cuprum met.

200

176 Cynodon Dactylon

Q

177 Cynodon Dactylon

3X

178 Cynodon Dactylon

30

179 Digitalis

Q

180 Digitalis

30

181 Digitalis

200

182 Dioscorea

30

183 Dioscorea

200

184 Diphtherinum

200

185 Drosera

30

186 Drosera

200

187 Dulcamara

30

188 Dulcamara

200

189 Echinacea

Q

190 Echinacea

30

191 Equisetum

30

192 Equisetum

200

193 Eupatorium Perf.

3X

194 Eupatorium Perf.

30

195 Eupatorium Perf.

200

196 Euphrasia

Q

197 Euphrasia

30

198 Euphrasia

200

199 Ferrum Met.

200

200 Flouric Acid

200

201 Formica Rufa

6

202 Formica Rufa

30

203 Gelsimium

3X

204 Gelsimium

6

70

205 Gelsimium

30

206 Gelsimium

200

207 Gelsimium

1M

208 Gentiana Chirata

6

209 Glonoine

30

210 Glonoine

200

211 Graphites

30

212 Graphites

200

213 Graphites

1M

214 Guaiacum

6

215 Guaiacum

200

216 Hamamelis Vir

Q

217 Hamamelis Vir

6

218 Hamamelis Vir

200

219 Helleborus

6

220 Helleborus

30

221 Hepar Sulph

6

222 Hepar Sulph

30

223 Hepar Sulph

200

224 Hepar Sulph

1M

225 Hippozaenium

6

226 Hydrastis

Q

227 Hydrocotyle As.

Q

228 Hydrocotyle As.

3X

229 Hyocyamus

200

230 Hypericum

Q

231 Hypericum

30

232 Hypericum

200

233 Hypericum

1m

234 Ignatia

30

235 Ignatia

200

236 Ignatia

1m

237 Iodium

30

238 Iodium

200

239 Iodium

1m

240 Ipecacuanha

Q

241 Ipecacuanha

3X

242 Ipecacuanha

6

243 Ipecacuanha

30

244 Ipecacuanha

200

245 Iris Tenax

6

246 Iris Veriscolor

30

71

247 Iris Veriscolor

200

248 Jonosia Ashoka

Q

249 Justicia Adhatoda

Q

250 Kali Bromatum

3X

251 Kali Carb

30

252 Kali Carb

200

253 Kali Carb

1M

254 Kali Cyanatum

30

255 Kali Cyanatum

200

256 Kali Iod

30

257 Kali Iopd

200

258 Kali Mur

30

259 Kali Mur

200

260 Kali Sulph

30

261 Kalmia Latifolium

30

262 Kalmia Latifolium

200

263 Kalmia Latifolium

1M

264 Kreosotum

Q

265 Kreosotum

30

266 Kreosotum

200

267 Lac Defloratum

30

268 Lac Defloratum

200

269 Lac Defloratum

1M

270 Lac Can

30

271 Lac Can

200

272 Lachesis

30

273 Lachesis

200

274 Lachesis

1M

275 Lapis Albus

3X

276 Lapis Albus

30

277 Ledum Pal

30

278 Ledum Pal

200

279 Ledum Pal

1M

280 Lillium Tig.

30

281 Lillium Tig.

200

282 Lillium Tig.

1M

283 Lobella inflata

Q

284 Lobella inflata

30

285 Lycopodium

30

286 Lycopodium

200

287 Lycopodium

1M

288 Lyssin

200

72

289 Lyssin

1M

290 Mag.Carb

30

291 Mag.Carb

200

292 Mag Phos

30

293 Mag Phos

200

294 Mag Phos

1M

295 Medorrhinum

200

296 Medorrhinum

1M

297 Merc Cor

6

298 Merc Cor

30

299 Merc Cor

200

300 Merc Sol

6

301 Merc Sol

30

302 Merc Sol

200

303 Merc Sol

1m

304 Mezerium

30

305 Mezerium

200

306 Millefolium

Q

307 Millefolium

30

308 Muriatic Acid

30

309 Muriatic Acid

200

310 Murex

30

311 Murex

200

312 Mygale

30

313 Naja Tri

30

314 Naja Tri

200

315 Natrum Ars

30

316 Natrum Ars

200

317 Natrum Carb

30

318 Natrum Carb

200

319 Natrum Carb

1M

320 Natrum Mur

6

321 Natrum Mur

30

322 Natrum Mur

200

323 Natrum Mur

1M

324 Natrum Phos

30

325 Natrum Sulph

30

326 Natrum Sulph

200

327 Natrum Sulph

1M

328 Nitric Acid

30

329 Nitric Acid

200

330 Nitric Acid

1M

73

331 Nux Vomica

6

332 Nux Vomica

30

333 Nux Vomica

200

334 Nux Vomica

1M

335 Nyctenthus Arbor

Q

336 Ocimum Sanctum

Q

337 Oleander

6

338 Petroleum

30

339 Petroleum

200

340 Petroleum

1M

341 Phosphoric Acid

Q

342 Phosphoric Acid

30

343 Phosphoric Acid

200

344 Phosphoric Acid

1M

345 Phosphorus

30

346 Phosphorus

200

347 Phosphorus

1M

348 Physostigma

30

349 Physostigma

200

350 Plantago Major

Q

351 Plantago Major

6

352 Plantago Major

30

353 Platina

200

354 Platina

1M

355 Plumbum Met

200

356 Plumbum Met

1M

357 Podophyllum

6

358 Podophyllum

30

359 Podophyllum

200

360 Prunus Spinosa

6

361 Psorinum

200

362 Psorinum

1M

363 Pulsatilla

30

364 Pulsatilla

200

365 Pulsatilla

1M

366 Pyrogenium

200

367 Pyrogenium

1M

368 Ranunculus bulbosus

30

369 Ranunculus bulbosus

200

370 Ranunculus repens

6

371 Ranunculus repens

30

372 Ratanhia

6

74

373 Ratanhia

30

374 Rauwolfia serpentina

Q

375 Rauwolfia serpentina

6

376 Rauwolfia serpentina

30

377 Rhododendron

30

378 Rhododendron

200

379 Rhus tox

3X

380 Rhus tox

6

381 Rhus tox

30

382 Rhus tox

200

383 Rhus tox

1M

384 Robinia

6

385 Robinia

30

386 Rumex crispus

6

387 Rumex crispus

30

388 Ruta gr

30

389 Ruta gr

200

390 Sabal serreulata

Q

391 Sabal serreulata

6

392 Sabina

3X

393 Sabina

6

394 Sabina

30

395 Sang.can

30

396 Sang.can

200

397 Sarsaprilla

6

398 Sarsaprilla

30

399 Secalecor

30

400 Secalecor

200

401 Selenium

30

402 Selenium

200

403 Senecio aureus

6

404 Sepia

30

405 Sepia

200

406 Sepia

1M

407 Silicea

30

408 Silicea

200

409 Silicea

1M

410 Spigellia

30

411 Spongia tosta

6

412 Spongia tosta

30

413 Spongia tosta

200

414 Stannum

30

75

415 Stannum

200

416 Staphisagria

30

417 Staphisagria

200

418 Staphisagria

1M

419 Sticta pulmonaria

6

420 Sticta pulmonaria

30

421 Stramonium

30

422 Stramonium

200

423 Sulphur

30

424 Sulphur

200

425 Sulphur

1M

426 Sulphuric acid

6

427 Sulphuric acid

30

428 Syphilinum

200

429 Syphilinum

1M

430 Tabacum

30

431 Tabacum

200

432 Tarentula cubensis

6

433 Tarentula cubensis

30

434 Tellurium

6

435 Tellurium

30

436 Terebinthina

6

437 Terebinthina

30

438 Terminalia arjuna

Q

439 Terminalia arjuna

3X

440 Terminalia arjuna

6

441 Thuja occidentalis

Q

442 Thuja occidentalis

30

443 Thuja occidentalis

200

444 Thuja occidentalis

1M

445 Thyroidinum

200

446 Thyroidinum

1M

447 Tuberculinum bov

200

448 Uran.Nit

3X

449 Urtica urens

Q

450 Urtica urens

6

451 Ustilago

6

452 Verat alb

6

453 Viburnan opulus

6

454 Viburnan opulus

30

455 Viburnan opulus

200

456 Vipera tor

200

76

457 Vipera tor

1M

458 Verat viride

30

459 Verat viride

200

460 Viscum album

6

461 Wyethia

6

462 Wyethia

30

463 Wyethia

200

464 Zinc met

200

465 Zinc met

1M

466 Zink phos

200

467 Zink phos

1M

468 Globules

20 no.

469 Sugar of milk 470 Glass Piles

5 ml

471 Glass Piles

10 ml

472 Butter Paper 473 Blank Sticker

1/2*3/2 inch

Ointments 474 Aesculus Hip 475 Arnica 476 Calendula 477 Cantharis 478 Hamamelis Vir 479 Rhus tox 480 Twelve Biochemic Medicines

6x & 12x

481 Cineraria Eye Drop 482 Euphrasia Eye Drop 483 Mullein Oil ( Ear Drop )

77

Annexure 10 Extracts from National Guidelines on Blood Storage Facilities at FRUs

1. Requirements Space: The area required for setting up the facility is only 10 square meters, well-lighted, clean and preferably air-conditioned.

Manpower: One of the existing doctors and technicians should be designated for this purpose. They should be trained in the operation of blood storage centers and other basic procedures like storage, grouping, cross- matching and release of blood.

The medical officer designated for this purpose will be responsible for overall working of the storage center.

Electricity: 24 hours supply is essential. Provision of back-up generator is required.

Equipment: Each FRU should have the following: 1. Blood bag refrigerators having a storage capacity of 50 units of blood. 2. Deep freezers for freezing ice packs required for transportation. The deep freezers available in the FRUs under the Immunization Programme can be utilized for this purpose. 3. Insulated carrier boxes with ice packs for maintaining the cold chain during transportation of blood bags. 4. Microscope and centrifuge: since these are an integral part of any existing laboratory, these would already be available at the FRUs. These should be supplied only if they are not already available.

Consumables: There should be adequate provision for consumables and blood grouping reagents. The following quantities would suffice the annual requirement of an FRU with up to 50 beds.

Consumables Quantity: Pasteur pipette 12 dozens / year Glass tubes 7.5 to 10 mm - 100 dozens / year Glass slides 1" x 2" boxes of 20 or 25 each / year Test tube racks 6 racks, each for 24 tables Rubber teats 6 dozens / year Gloves Disposable rubber gloves 500 pairs per year

78

Blotting tissue paper As required Marker pencil (alcohol based) As required Tooth picks As required Reagents: All the reagents should come from the Mother Blood Bank. Anti-A 2-vials each per month Anti-B 2-vials each per month Anti-AB 2-vials each per month Anti-D (Blend of IgM & IgG) 2 vials each per month Antihuman Globulin 1 vial per month (Polyclonal IgG & Complement)

Since quality of the reagents is an important issue, the supplies of these should be made from the same blood bank/center from where blood is obtained. For this purpose, State Governments/Union Territories should provide the additional budgetary requirements to the mother blood bank/center.

Disinfectants: Bleach & Hypochlorite Solution - As required

2. Suggested quantities of Whole Blood Units to be available at a Blood Storage Units 5 units each of A, B, O (Positive) 2 units of AB (Positive) 1 units each of A, B & O (Negative) This can be modified according to the actual requirement

3. Storage & transportation Cold chain: It is necessary to maintain the cold chain at all levels i.e. from the mother center to the blood storage center to the issue of blood. This can be achieved by using insulated carrier boxes. During transportation, the blood should be properly packed into cold boxes surrounded by the ice packs. Ice, if used should be clean and should not come in direct contact with the blood bags. The blood should be kept in blood bank refrigerator at 4º-6ºc ± 2ºc. The temperature of the blood should be monitored continuously.

Storage: The storage center should check the condition of blood on receipt from the mother center and also during the period of storage. The responsibility of any problem arising from storage, cross matching, issue and transfusion will be of the storage center. Any unit of blood showing hemolysis, turbidity or change in colour should not be taken on stock for transfusion. Due care should be taken to maintain sterility of blood by keeping all storage areas clean. The

79

expiry of the blood is normally 35/42 days depending on the type of blood bags used. The Medical Officer in-charge should ensure that unused blood bags should be returned to the mother center at least 10 days before the expiry of the blood and fresh blood obtained in its place. The blood storage centers are designed to ensure rapid and safe delivery of whole blood in an emergency. The detail of storage of packed cells, fresh frozen plasma and platelets concentrate are therefore not given in these guidelines. In case, however, these are required to be stored, the storage procedures of the mother blood bank should be followed.

4. Issue of blood Patients blood grouping and cross matching should invariably be carried out before issue of blood. A proper record of this should be kept.

First In and First Out (FIFO) policy, whereby blood closer to expiry date is used first, should be followed.

5. Disposal Since all the blood bags will already be tested by the mother center, disposal of empty blood bags should be done by landfill. Gloves should be cut and put in bleach for at least one hour and then disposed as normal waste.

6. Documentation & records The center should maintain proper records for procurement, cross matching and issue of blood and blood components. These records should be kept for at least 5 years.

7. Training Training of doctors and technicians, who will be responsible for the Blood Storage Center, should be carried out for 3 days in an identified center as per the guidelines. Training will include: • Pre-transfusion checking, i.e. patient identity and grouping • Cross matching • Compatibility • Problems in grouping and cross matching • Troubleshooting • Issue of blood • Transfusion reactions and its management • Disposal of blood bags

80

The states will have to identify the institutions where training of the staff responsible for running the blood bank is to be held. These could be the blood banks at Medical Colleges, Regional Blood Banks, Indian Red Cross Blood Banks, or any other well setup, licensed Blood Bank, provided they have the necessary infrastructure for undertaking training.

The training will be for three-days duration during which the Medical Officer and the technician from the identified FRUs will be posted at the training institution. A "Standard Operating Procedures Manual" (SOPM) has been developed and is part of these guidelines. This SOPM will be used as the training material. A copy of this SOPM will be made available to the Medical Officer for use in his Blood Storage Center for undertaking storage, grouping, cross matching and transfusion.

In addition to the training of the above Medical Staff, it is considered necessary that the clinicians who will be responsible for prescribing the use of blood are also sensitized on the various parameters of blood transfusion. For this the "Clinician's Guide to Appropriate Use of Blood" has been developed. It is suggested that one-day sensitization programme for the clinicians may be organized at the District Hospital/Medical College.

Government of India will make the expenditure for the above-mentioned trainings, available as per the norms of training under the RCH Programme. This training will, however, be coordinated by the Training Division of Department of Family Welfare. The states are required to include training as part of the overall State Action Plan for establishing Blood Storage Centers. ****

Equipments for Laboratory Tests & Blood Transfusion Rod, flint-glass, 1000 x 10 mm dia, set of two 2 Cylinder, measuring, graduated W/pouring lip, glass, 50 ml 2 Bottle, wash, polyethylene W/angled delivery tube, 250 ml 1 Timer, clock, interval, spring wound, 60 minutes x 1 minute 1 Rack, slide drying nickel/silver, 30 slide capacity 1 Tray, staining, stainless steel 450 x 350 x 25 mm 1 Chamber, counting, glass, double neubauer ruling 2 Pipette, serological glass, 0.05 ml x 0.0125 ml 6 Pipette, serological glass, 1.0 ml x 0.10 ml 6 Counter, differential, blood cells, 6 unit 1 Centrifuge, micro-hematocrit, 6 tubes, 240v 1

81

Cover glass for counting chamber (item 7), Box of 12 1 Tube, capillary, heparinized, 75 mm x 1.5 mm, vial of 100 10 Lamp, spirit W/screw cap. Metal 60 ml 1 Lancet, blood (Hadgedorn needle) 75 mm pack of 10 ss 10 Benedict’s reagent qualitative dry components for soln 1 Pipette measuring glass, set of two sizes 10 ml, 20 ml 2 Test tube, w/o rim, heat resistant glass, 100 x 13 mm 24 Clamp, test-tube, nickel plated spring wire, standard type 3 Beaker, HRG glass, low form, set of two sizes, 50 ml, 150 ml 2 Rack, test-tube wooden with 12 x 22 mm dia holes 1

82

Annexure 11 LIST OF LABORATORY SERVICES S. No.

I.

Speciality

Diagnostic Services / Tests

CLINICAL PATHOLOGY a. Haematology

Haemoglobin estimation Total Leucocyte count Differential Leucocyte count Absolute Eosinophil count Reticulocyte count Total RBC count E.S.R. Peripheral Blood Smear Malaria/Filaria Parasite Platelet count Packed Cell volume Blood grouping Rh typing Blood Cross matching

b. Urine Analysis

Urine for Albumin, Sugar, Deposits, bile salts, bile pigments, acetone, specific gravity, Reaction (pH)

c. Stool Analysis

Stool for Ovacyst (Eh) Hanging drop for V. Cholera Occultblood

II.

PATHOLOGY b. Sputum

S. No.

III.

Sputum cytology Speciality

Diagnostic Services / Tests

MICROBIOLOGY Smear for AFB, KLB Grams Stain for Throat swab, sputum etc.

IV.

SEROLOGY

VDRL Pregnancy test (Urine gravindex) WIDAL test

83

Sl. No.

V.

Speciality BIOCHEMISTRY

Diagnostic Services / Tests Blood Sugar Blood urea Liver function tests Kidney function tests Blood Cholesterol

VI.

CARDIAC INVESTIGATIONS

a) ECG

VII.

OPHTHALMOLOGY

a) Refraction by using Snellen's chart Retinoscopy Ophthalmoscopy

IX.

RADIOLOGY

a) Xray for Chest, Skull, Spine, Abdomen, bones e) Dental Xray f) Ultrasonography

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Annexure 12

Model Citizens Charter for CHCs

1.

Preamble

Community Health Centres and Primary Health Centres exist to provide health care to every citizen of India within the allocated resources and available facilities. The Charter seeks to provide a framework which enables citizens to know. •

What services are available.

•

The quality of services they are entitled to.

•

The means through which complaints regarding denial or poor qualities of services will be addressed.

2.

Objectives •

To make available medical treatment and the related facilities for citizens.

•

To provide appropriate advice, treatment and support that would help to cure the ailment to the extent medically possible.

•

To ensure that treatment is best on well considered judgment, is timely and comprehensive and with the consent of the citizen being treated.

•

To ensure you just awareness of the nature of the ailment, progress of treatment, duration of treatment and impact on their health and lives, and

•

3.

To redress any grievances in this regard.

Commitments of the Charter •

To provide access to available facilities without discrimination,

•

To provide emergency care, if needed on reaching the CHC/ PHC

•

To provide adequate number of notice boards det ailing the location of all the facilities.

•

To provide written information on diagnosis, treatment being administered.

•

To record complaints and designate appropriate officer, who will respond at an appointed time, that may be same day in case of inpatients and the next day in case of out patients.

4.

Component of service at CHCs

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•

Access to CHCs and professional medical care to all

•

Making provision for emergency care after main treatment hour whenever needed

•

Informing users about available facilities, costs involved and requirements expected of them with regard to the treatment in clear and simple terms.

•

Informing users of equipment out of order

•

Ensuring that users can seek clarifications and assistance in making use of medical treatment and CHC facility.

•

Informing users about procedures for reporting in-efficiencies in services or nonavailability of facilities.

5.

Grievance redressal •

Grievances that citizens have will be recorded

•

There will be a designated officer to respond to the request deemed urgent by the person recording the grievance

•

Aggrieved user after his/her complaint recorded would be allowed to seek a second opinion within the CHC

•

To have a public grievance committee outside the CHC to deal with the grievances that are not resolved within the CHC.

6.

Responsibilities of the users •

Users of CHC would attempt to understand the commitments made in the charter

•

User would not insist on service above the standard set in the charter because it could negatively affect the provision of the minimum acceptable level of service to another user.

•

Instruction of the CHC’s personnel would be followed sincerely, and

•

In case of grievances, the redressal mechanism machinery would be addressed by users without delay.

7.

Performance audit and review of the charter •

Performance audit may be conducted through a peer review every two or three years after covering the areas where the standards have been specified

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Annexure 13

Composition of the Task Group III and the Consultation Process

Under the National Rural Health Mission 8 Task Groups have been constituted to deliberate upon various issues concerning the Operationalisation of National Rural Health Mission. These task th

Groups were assigned the various tasks at the meeting held on 10 Feb.2005. The following is the description of the process involved ion the preparation of the Document for developing IPHS for CHCs as detailed below. Task Group III comprised the following members: 1.

Dr.Imrana Quader, JNU

2.

Mrs.Brinda Karat

3.

Mr.Satish Agnihotri, IAS

4.

Dr.Ravi Narayan, CHC

5.

Mrs.Sheela Rani Chungat, Secretary(Health, Tamil Nadu)

6.

Mr.Ram Lubaya, IAS, Govt. of Rajasthan

7.

Dr.Mohan Rao, JNU

8.

Dr.Mira Shiva, VHAI

9.

Dr.S.P.Aggarwal, Director General Health Services: Chairperson

10. Dr.Jean Dreze, NAC 11. Mr.P.R.Krishna Kumar 12. Mr.Taradatt, JS,(AYUSH) 13. Dr.I.S.Pal, DG (FW), Uttaranchal 14. Mr.S.R.Mohanty, Madhya Pradesh 15. Dr.Abhay Shukla, CEHAT 16. Dr.S.K.Satpathy, DC (ID), Rapporteur

The Task Group was asked to prepare Status papers on the following four issues: • Strengthening of Public health Institutions • Setting up of Indian Public health Standards for health care delivery in Community Health Centres • Ensuring availability of doctors in rural areas • Mainstreaming of AYUSH

As a follow-up to the meeting the DG HS reviewed the progress on a daily basis with members of the directorate and also experts from outside who were invited to join the process. The 4 papers were prepared and sent to all the members electronically and were also given print copies. The

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th

second meeting of the Task Group III held on the 26 Feb.2005 under the Chairmanship of Dr. S. P. Agarwal, DGHS, at Nirman Bhawan, New Delhi. Secretary (Health & Family Welfare) also participated in the discussion briefly. The list of Members / their representatives and various experts who participated in the meeting was as follows:

Dr. S. P. Agarwal, Director General Health Services: Chairperson Dr. Imrana Quader, JNU Dr. Thelma Narayan, CHC Dr. S. Murugan, Director (FW Tamil Nadu) Dr. Mohan Rao, JNU Dr. Mira Shiva, VHAI Mr. S. R. Mohanty, Madhya Pradesh Mr. B. Venkataraman, QCI Dr. Abhay Shukla, CEHAT Mr. B. P. Sharma, JS Dr. S. K. Sharma, Adviser, AYUSH Dr. C. S. Pandav, AIIMS Dr. Ichhpujani, DDG (P) Dr. D. C. Jain, DC (CH/T) Dr. A. K. Harit, CMO, DGHS Dr. A. N. Sinha, CMO (HA) Dr. Sadhana Bhagwat, Consultant, Cancer Dr. Praveena Goel, AC (UH) Dr. Himanshu Bhushan, AC (MH-II) Mrs. Mridula Das, ADG (N) Mrs. Shubhra Singh, Director (P/RHM) Mr. Babu Lal, Director (ID) Dr. S. K. Satpathy, DC (ID), Rapporteur

These papers were discussed with the members present. Subsequent to the meeting, inputs from the deliberations were added to the papers. Further consultations were held on a daily basis with the members available at the Directorate and external experts. Another meeting with the various th

National Health Programme Officers and experts was also held on 7 March 2005.

The document on IPHS was prepared initially aiming at setting up standards for the CHCs. But after discussion with Director (P/RHM), the paper was scaled down to discuss the requirements for minimum functional grading of CHCs with scope for further up gradation. Inputs were taken

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from the Programme Officers of National Health Programmes, consultants from accreditation agencies and also from Department of Community Medicine, AIIMS, for preparation of the documents.

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List of Abbreviations

ANM ASHA BCC CHC CSSD CSSM DOT DTC FRU IEC Inj IPHS IUCD JE LTs MC MIS MO MPWs NAMP NLEP NRHM NHP NVBDCP OT PHC PPTCT : PRI RCH RNTCP : RTI / STI

: : : : : : : : : : : : : : : : : : : : : : : : : :

SOPs STPs STLS VCTC

: : : :

: : :

Auxiliary Nurse Midwife Accredited Social Health Activists Behaviour Change Communication Community Health Centres Central Sterile and Supply Department Child Survival and Safe Motherhood Direct Observed Treatment District Tuberculosis Centre First Referral Unit Information, Education and Communication Injection Indian Public Health Standards Intra-urine Contraceptive Devise Japanese Encephalitis Laboratory Technicians Microscopic Centre Management Information System Medical Officer Multi Purpose Workers National Anti Malaria Program National Leprosy Eradication Program National Rural Health Mission National Health Program National Vector Borne Disease Control Program Operation Theatre Primary Health Centre Prevention of Parent to Child Transmission Panchayati Raj Institution Reproductive & Child Health Revised National Tuberculosis Control Program Reproductive Tract Infections / Sexual Tract Infections Standard Operating Procedures Standard Treatment Protocols Senior Tuberculosis Laboratory Supervisor Voluntary Counseling and Testing Centre

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